MEDICARE: MS. ANDREA C SOLER LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1016219	MA

General Provider Information

NPI Number	:	1225037070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA C SOLER LICSW

Provider Business Mailing Address
First Line	:	PO BOX 718
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-0035
Country	:	US
Telephone Number	:	617-264-9977
Fax Number	:

Provider Business Practice Location Address
First Line	:	640 CENTRE ST
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-2555
Country	:	US
Telephone Number	:	617-264-9977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/08/2007

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