Healthcare Provider Details

I. General information

NPI: 1649508326
Provider Name (Legal Business Name): MISS XIAODAN ZHOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 SOUTH ST
BOSTON MA
02111-2826
US

IV. Provider business mailing address

145 SOUTH ST
BOSTON MA
02111-2826
US

V. Phone/Fax

Practice location:
  • Phone: 617-521-6731
  • Fax: 617-457-6696
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116822
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: