Healthcare Provider Details

I. General information

NPI: 1649610924
Provider Name (Legal Business Name): JANICE MAHAL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANICE CHAVEZ LICSW

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

687 HIGHLAND AVE
NEEDHAM MA
02494-2232
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6040
  • Fax:
Mailing address:
  • Phone: 800-455-8726
  • Fax: 866-455-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119616
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: