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General NPI Number Information
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NPI Number | 1740795004
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Entity Type | Individual
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Provider Name | FAITH WOOD BREISBLATT MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 1470 BEACON ST APT A
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City | BROOKLINE
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State | MA
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Zip | 02446-2613
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Country | US
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Telephone | 617-487-4909
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Fax | 617-487-4909
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Provider Business Mailing Address
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Address Line | 21 TILESTON ST APT 4
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City | BOSTON
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State | MA
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Zip | 02113-1965
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Country | US
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Telephone | 602-312-0703
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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 | 120673
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License Number State | MA
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