=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386443893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE EMPOWERMENT PRACTICE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2025
-----------------------------------------------------
Last Update Date | 03/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 867 BOYLSTON STREET 5TH FL. STE. 1930
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02116-2774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-383-7309
-----------------------------------------------------
Fax | 617-977-5595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 867 BOYLSTON STREET 5TH FL. STE. 1930
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02116-2774
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-383-7309
-----------------------------------------------------
Fax | 617-977-5595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GINNELLE VASQUEZ
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 617-383-7309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------