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General NPI Number Information
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NPI Number | 1831703859
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Entity Type | Individual
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Provider Name | SALVATORE JAMES AZEVEDO
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Gender | Male
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 340 MAPLE ST
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City | MARLBOROUGH
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State | MA
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Zip | 01752-3200
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Country | US
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Telephone | 508-283-5192
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Fax |
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Provider Business Mailing Address
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Address Line | 340 MAPLE ST
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City | MARLBOROUGH
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State | MA
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Zip | 01752-3200
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Country | US
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Telephone | 508-283-5192
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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 | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 4141
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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