Healthcare Provider Details

I. General information

NPI: 1114154523
Provider Name (Legal Business Name): NADINE M JONES-RUFFIN LSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADINE M JONES-RUFFIN MS, LSWA

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LEXINGTON ST
EAST BOSTON MA
02128-1666
US

IV. Provider business mailing address

2 LEXINGTON ST
EAST BOSTON MA
02128-1666
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-4561
  • Fax: 617-418-8133
Mailing address:
  • Phone: 617-569-4561
  • Fax: 617-418-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number413078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: