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General NPI Number Information
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NPI Number | 1699323584
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Entity Type | Individual
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Provider Name | MAHLET MESHESHA LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/03/2019
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Provider Practice Location Address
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Address Line | 30 WARREN ST
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City | BRIGHTON
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State | MA
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Zip | 02135-3680
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Country | US
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Telephone | 202-609-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 866 WASHINGTON ST APT 1
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City | DORCHESTER
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State | MA
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Zip | 02124-4876
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Country | US
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Telephone | 202-509-1230
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 000225046
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License Number State | MA
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