Healthcare Provider Details

I. General information

NPI: 1992156228
Provider Name (Legal Business Name): HANNAH WAGNER SPIRO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STANIFORD ST 2ND FLOOR
BOSTON MA
02114-2503
US

IV. Provider business mailing address

44 FAIRBANKS ST APT. 2
BRIGHTON MA
02135-2504
US

V. Phone/Fax

Practice location:
  • Phone: 617-523-1529
  • Fax: 617-523-1207
Mailing address:
  • Phone: 413-230-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: