Healthcare Provider Details

I. General information

NPI: 1639663263
Provider Name (Legal Business Name): TSITSI MOYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 AUBURN ST APT 4
FRAMINGHAM MA
01701-4849
US

IV. Provider business mailing address

45 AUBURN ST APT 4
FRAMINGHAM MA
01701-4849
US

V. Phone/Fax

Practice location:
  • Phone: 508-904-8895
  • Fax:
Mailing address:
  • Phone: 508-904-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number217085
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: