Healthcare Provider Details

I. General information

NPI: 1295247856
Provider Name (Legal Business Name): BEATRICE PUZIKOV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 RAILROAD AVE
SWAMPSCOTT MA
01907-1821
US

IV. Provider business mailing address

5 BRAEMORE RD APT 21
BRIGHTON MA
02135-7043
US

V. Phone/Fax

Practice location:
  • Phone: 781-600-5501
  • Fax:
Mailing address:
  • Phone: 617-283-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: