Healthcare Provider Details

I. General information

NPI: 1255244968
Provider Name (Legal Business Name): ERIC ZHAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MASSACHUSETTS AVE STE 12
CAMBRIDGE MA
02139-3309
US

IV. Provider business mailing address

17 SEWALL ST
SOMERVILLE MA
02145-1955
US

V. Phone/Fax

Practice location:
  • Phone: 617-852-1553
  • Fax:
Mailing address:
  • Phone: 978-201-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2143494
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: