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General NPI Number Information
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NPI Number | 1922405232
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Entity Type | Organization
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Legal Business Name | LUZ STELLA LOAIZA
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 47 PHEASANT ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-3011
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Country | US
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Telephone | 617-637-5250
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Fax |
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Provider Business Mailing Address
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Address Line | 47 PHEASANT ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-3011
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Country | US
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Telephone | 617-637-5250
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. LUZ STELLA LOAIZA
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Credential | LCSW
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Telephone | 617-637-5250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | S37025870
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License Number State | MA
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