MEDICARE: JUDITH MARY BREEN 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	113840	MA

General Provider Information

NPI Number	:	1518446145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH MARY BREEN LICSW

Provider Business Mailing Address
First Line	:	144 MANTHORNE RD # 1
Second Line	:
City	:	WEST ROXBURY
State	:	MA
Zip	:	02132-1502
Country	:	US
Telephone Number	:	617-325-9035
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 OAKLAND ST
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-5338
Country	:	US
Telephone Number	:	781-237-2161
Fax Number	:	781-997-1147

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	08/14/2018

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