MEDICARE: GELEN ZEPEDA MA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1942633748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GELEN ZEPEDA MA

Provider Business Mailing Address
First Line	:	89 MIDDLESEX RD APT 8
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02452-6167
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1544 COLUMBUS AVE
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-1026
Country	:	US
Telephone Number	:	857-366-7040
Fax Number	:

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

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	05/17/2016

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Directions to “ GELEN ZEPEDA MA” Practice Location

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