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General NPI Number Information
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NPI Number | 1114631280
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Entity Type | Individual
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Provider Name | JUDITH TAVERAS MSW, LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 300 LONGWOOD AVE
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City | BOSTON
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State | MA
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Zip | 02115-5724
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Country | US
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Telephone | 617-355-8593
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Fax |
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Provider Business Mailing Address
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Address Line | 29 TROTTER RD UNIT 212
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City | SOUTH WEYMOUTH
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State | MA
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Zip | 02190-4142
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Country | US
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Telephone | 401-301-4468
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 226177
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License Number State | MA
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