Healthcare Provider Details

I. General information

NPI: 1336974484
Provider Name (Legal Business Name): MR. CHRISTOPHER ERNESTO AZEVEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DURFEE ST
FALL RIVER MA
02720-2126
US

IV. Provider business mailing address

22 FREDERICK ST
NEW BEDFORD MA
02744-2214
US

V. Phone/Fax

Practice location:
  • Phone: 508-984-4155
  • Fax: 508-994-4514
Mailing address:
  • Phone: 508-264-1052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: