Healthcare Provider Details

I. General information

NPI: 1174791628
Provider Name (Legal Business Name): PAULA C VASS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HOPE AVE SUITE 500
WALTHAM MA
02453-2741
US

IV. Provider business mailing address

89 SHERBOURNE PL
WALTHAM MA
02451-7318
US

V. Phone/Fax

Practice location:
  • Phone: 781-647-6720
  • Fax: 781-647-6752
Mailing address:
  • Phone: 339-927-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111589
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: