MEDICARE: MR. CHRISTOPHER ERNESTO AZEVEDO

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	:	1336974484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER ERNESTO AZEVEDO

Provider Business Mailing Address
First Line	:	22 FREDERICK ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02744-2214
Country	:	US
Telephone Number	:	508-264-1052
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 DURFEE ST
Second Line	:
City	:	FALL RIVER
State	:	MA
Zip	:	02720-2126
Country	:	US
Telephone Number	:	508-984-4155
Fax Number	:	508-994-4514

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

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	09/06/2024

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