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General NPI Number Information
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NPI Number | 1043377450
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Entity Type | Individual
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Provider Name | JODI LISA ROME-AVRUS M.ED.
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 VICTORY RD
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City | QUINCY
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State | MA
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Zip | 02171-3139
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Country | US
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Telephone | 617-774-1089
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Fax |
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Provider Business Mailing Address
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Address Line | 41 JONES AVE
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City | RANDOLPH
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State | MA
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Zip | 02368-3701
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Country | US
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Telephone | 781-986-7431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 171M00000X
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License Number State | MA
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