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General NPI Number Information
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NPI Number | 1467641126
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Entity Type | Organization
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Legal Business Name | BOSTON HEALTHCARE VA
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 204 BELLINGHAM AVE
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City | REVERE
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State | MA
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Zip | 02151-4106
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Country | US
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Telephone | 440-915-6515
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Fax |
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Provider Business Mailing Address
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Address Line | 204 BELLINGHAM AVE
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City | REVERE
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State | MA
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Zip | 02151-4106
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Country | US
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Telephone | 440-915-6515
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Fax |
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Authorized Official
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Title or Position | POSTDOCTORAL FELLOW
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Name | ADRIANA FAUR
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Credential | M.A.
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Telephone | 857-364-4122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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