Healthcare Provider Details

I. General information

NPI: 1548428048
Provider Name (Legal Business Name): TUAN Q CAO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 WILLARD ST
QUINCY MA
02169-7482
US

IV. Provider business mailing address

859 WILLARD ST
QUINCY MA
02169-7482
US

V. Phone/Fax

Practice location:
  • Phone: 617-847-1950
  • Fax: 617-774-1490
Mailing address:
  • Phone: 617-847-1950
  • Fax: 617-774-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number213963
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: