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NPI Code Detail

MEDICARE: CECILIA TATEM SMALL MSW, LICSW

MEDICARE:   CECILIA  TATEM SMALL  MSW, LICSW
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
11041C0700XClinical Social Worker1022290MA

General Provider Information

NPI Number : 1114333119
Entity Type Code : Individual
Provider Name (Legal Business Name) : CECILIA TATEM SMALL MSW, LICSW
Provider Business Mailing Address
First Line : 257 AYER RD
Second Line :
City : HARVARD
State : MA
Zip : 01451-1108
Country : US
Telephone Number : 978-772-4457
Fax Number :
Provider Business Practice Location Address
First Line : 257 AYER RD
Second Line :
City : HARVARD
State : MA
Zip : 01451-1108
Country : US
Telephone Number : 978-772-4457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2014
Last Update Date : 07/10/2014

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Directions to “ CECILIA TATEM SMALL MSW, LICSW” Practice Location

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