Healthcare Provider Details

I. General information

NPI: 1942144258
Provider Name (Legal Business Name): MS. CARMEN ANNETTE PANTOJA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WORCESTER RD
WEBSTER MA
01570-2106
US

IV. Provider business mailing address

104 WORCESTER RD
WEBSTER MA
01570-2106
US

V. Phone/Fax

Practice location:
  • Phone: 774-417-7041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberSA1961552
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: