Healthcare Provider Details

I. General information

NPI: 1013526920
Provider Name (Legal Business Name): NAOMI JANE DYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

15 PARKMAN ST # 037
BOSTON MA
02114-3117
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-1482
  • Fax:
Mailing address:
  • Phone: 617-726-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: