MEDICARE: CHRISTINE ANGELA LETTERIELLO LSW MASS BOARD OF SW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1114255346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ANGELA LETTERIELLO LSW MASS BOARD OF SW

Provider Business Mailing Address
First Line	:	23 WHITE ST
Second Line	:
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-1348
Country	:	US
Telephone Number	:	617-569-4741
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 WHITE ST
Second Line	:
City	:	EAST BOSTON
State	:	MA
Zip	:	02128-1348
Country	:	US
Telephone Number	:	617-569-4741
Fax Number	:

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

Provider Enumeration Date	:	11/30/2009
Last Update Date	:	11/30/2009

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