MEDICARE: MS. SUSY KATE JOFI NGALE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1073189411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSY KATE JOFI NGALE

Provider Business Mailing Address
First Line	:	4380 N MAIN ST APT 509
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02720-1713
Country	:	US
Telephone Number	:	612-325-8140
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 COURT ST STE 3
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-7351
Country	:	US
Telephone Number	:	857-939-3682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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