Healthcare Provider Details

I. General information

NPI: 1891845822
Provider Name (Legal Business Name): NATHALIE BAZIL BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MASSACHUSETTS AVE
BOSTON MA
02118-2600
US

IV. Provider business mailing address

1010 MASSACHUSETTS AVE
BOSTON MA
02118-2600
US

V. Phone/Fax

Practice location:
  • Phone: 617-419-3408
  • Fax: 617-534-2611
Mailing address:
  • Phone: 617-419-3408
  • Fax: 617-534-2611

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 Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: