Healthcare Provider Details

I. General information

NPI: 1750109757
Provider Name (Legal Business Name): JUDITH BIH TASANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 GREAT MEADOW RD
DEDHAM MA
02026-4090
US

IV. Provider business mailing address

7000 GREAT MEADOW RD
DEDHAM MA
02026-4090
US

V. Phone/Fax

Practice location:
  • Phone: 617-606-0409
  • Fax:
Mailing address:
  • Phone: 617-606-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2259842
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: