Healthcare Provider Details

I. General information

NPI: 1255976411
Provider Name (Legal Business Name): CORI ANN TAITZ M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 HANCOCK ST
QUINCY MA
02169-4313
US

IV. Provider business mailing address

19 COLUMBIA ST
BROOKLINE MA
02446-2479
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-8400
  • Fax:
Mailing address:
  • Phone:
  • 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: