Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mark A Deyab, LICSW

Individual provider Mental Health Counselor · NPI 1104907732

Mark A Deyab, LICSW is a Clinical Social Worker in Waltham, Massachusetts. Qualified in 1994, 32 years ago. Offers telehealth. Licensed in Massachusetts.

Years since qualifying
32
Licensed in
MA
In the registry since
2006
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

20 Hope Ave G-05
Waltham, MA 02453-2721
Phone: (781) 799-3949
Fax: (781) 899-6386
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X · Licence 111824 (MA)

Record details

NPI number1104907732
Entity typeIndividual (Type 1)
GenderMale
Credentials LICSW
Sole proprietorNo
NPI enumeratedOctober 18, 2006
Last updated in NPPESMarch 17, 2009
Mailing address34 Wareham St, Apt. 1, Medford, MA 02155-6222

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1994 (32 years in practice)
Accepts Medicare assignment Not indicated
TelehealthOffers telehealth services

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