Healthcare Provider Details

I. General information

NPI: 1831786052
Provider Name (Legal Business Name): MS. DEBORAH QUAGLOZZI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

617 LEXINGTON ST
WALTHAM MA
02452-3003
US

IV. Provider business mailing address

36 BRUCE RD
WALTHAM MA
02453-6965
US

V. Phone/Fax

Practice location:
  • Phone: 781-893-8050
  • Fax:
Mailing address:
  • Phone: 617-640-1143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number107059
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number107059
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: