Healthcare Provider Details

I. General information

NPI: 1528552015
Provider Name (Legal Business Name): GIOVANNI MUNOZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 BLUE HILL AVE
BOSTON MA
02124-2902
US

IV. Provider business mailing address

33 WARREN AVE
MANSFIELD MA
02048-1328
US

V. Phone/Fax

Practice location:
  • Phone: 617-506-8188
  • Fax:
Mailing address:
  • Phone:
  • 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: