Healthcare Provider Details

I. General information

NPI: 1285850107
Provider Name (Legal Business Name): CECILIA E JUAREZ ESPINOZA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

IV. Provider business mailing address

145 LEXINGTON ST # 31
AUBURNDALE MA
02466-1357
US

V. Phone/Fax

Practice location:
  • Phone: 617-425-2000
  • Fax: 617-425-2043
Mailing address:
  • Phone: 617-775-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: