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NPI Code Detail

MEDICARE: CHARLES L ISRAEL II

MEDICARE: CHARLES L ISRAEL II
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
1101YM0800XMental Health Counselor
2104100000XSocial Worker

General Provider Information

NPI Number : 1205262573
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES L ISRAEL II
Provider Business Mailing Address
First Line : 37 CEDAR ST
Second Line :
City : MATTAPAN
State : MA
Zip : 02126-2924
Country : US
Telephone Number : 617-839-1050
Fax Number :
Provider Business Practice Location Address
First Line : 504 DUDLEY ST
Second Line :
City : ROXBURY
State : MA
Zip : 02119-2732
Country : US
Telephone Number : 617-989-9499
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2013
Last Update Date : 09/18/2013

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Directions to “ CHARLES L ISRAEL II ” Practice Location

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