Healthcare Provider Details

I. General information

NPI: 1821278391
Provider Name (Legal Business Name): ENEIDA JUSINO MADHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DRIVE SUITE 205
SPRINGFIELD MA
01199-0001
US

IV. Provider business mailing address

70 EDGEWOOD ST
SPRINGFIELD MA
01109-3025
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-9816
  • Fax:
Mailing address:
  • Phone: 413-737-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: