Healthcare Provider Details

I. General information

NPI: 1144175241
Provider Name (Legal Business Name): GEORGIA NOGUEIRA DESOUZA PATU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEORGIA PATU

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MORTON ST
BOSTON MA
02130-3735
US

IV. Provider business mailing address

66 CANAL ST
BOSTON MA
02114-2002
US

V. Phone/Fax

Practice location:
  • Phone: 617-318-5118
  • Fax:
Mailing address:
  • Phone: 617-371-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: