MEDICARE: TEACHER TALK LLC

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1144871914	OTHER	MA	NPI

General Provider Information

NPI Number	:	1083200646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEACHER TALK LLC

Provider Business Mailing Address
First Line	:	25 GOTHLAND ST APT E
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-1841
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 GOTHLAND ST APT E
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-1841
Country	:	US
Telephone Number	:	857-327-5528
Fax Number	:

Authorized Official
Title or Position	:	LICSW
Name	:	MARY MARGARET LANE
Credential	:	LICSW
Telephone Number	:	857-327-5528

Provider Enumeration Date	:	12/17/2020
Last Update Date	:	12/17/2020

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Directions to “TEACHER TALK LLC ” Practice Location

Language	Start Address	Practice Location

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