Healthcare Provider Details

I. General information

NPI: 1750447900
Provider Name (Legal Business Name): JOANNE TAUB LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 HASTINGS ST
MENDON MA
01756-1090
US

IV. Provider business mailing address

32 DUNCKLEE ST
NEWTON HIGHLANDS MA
02461-1115
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-1200
  • Fax: 508-473-1226
Mailing address:
  • Phone: 617-965-1489
  • Fax: 617-332-0417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1029117
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9373299
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA ID NUMBER
# 2
IdentifierPO8648
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: