Healthcare Provider Details

I. General information

NPI: 1083152425
Provider Name (Legal Business Name): SABINA TAVARES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 PUTNAM ST 3
EAST BOSTON MA
02128-1461
US

IV. Provider business mailing address

172 PUTNAM ST 3
EAST BOSTON MA
02128-1461
US

V. Phone/Fax

Practice location:
  • Phone: 617-359-2146
  • Fax:
Mailing address:
  • Phone: 617-359-2146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SABINA FERREIRA TAVARES
Title or Position: NURSE
Credential: RN
Phone: 617-359-2146