Mark A Deyab, LICSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

111824 Issued in MA

Practice address

20 Hope Ave
G-05
Waltham, MA 02453-2721

Phone

(781) 799-3949

Fax

(781) 899-6386

NPI assigned

Oct 18, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1994

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mark Deyab Licsw Inc

  • Clinical Social Worker
  • Melrose, MA
  • NPI 1750715108
  Medicare reassignment Authorized official
• Boston Psychiatry Group, Inc.

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Waltham, MA
  • NPI 1205934924
  NPD (past)
• Northeast Behavioral Health Corporation

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beverly, MA
  • NPI 1154302586
  NPD (past)
• Wilmington Family Counseling Service Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wilmington, MA
  • NPI 1922043447
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237248000000",
    "number": "1104907732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 WAREHAM ST",
            "address_2": "APT. 1",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021556222",
            "telephone_number": "781-799-3949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 HOPE AVE",
            "address_2": "G-05",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024532721",
            "telephone_number": "781-799-3949",
            "fax_number": "781-899-6386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEYAB",
        "first_name": "MARK",
        "middle_name": "A",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2009-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "111824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Waltham, MA
• Providers in Waltham, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.