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NPI Code Detail

MEDICARE: MS. TRACY MICHELLE WALTERS

MEDICARE: MS. TRACY MICHELLE WALTERS
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1467590612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRACY MICHELLE WALTERS
Provider Business Mailing Address
First Line : 365 FANEUIL ST
Second Line : #3
City : BRIGHTON
State : MA
Zip : 02135-2561
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 105 VICTORY RD
Second Line :
City : DORCHESTER
State : MA
Zip : 02122-3518
Country : US
Telephone Number : 617-371-3010
Fax Number : 617-371-3044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2007
Last Update Date : 07/08/2007

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