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NPI Code Detail

MEDICARE: MR. EDWARD JAMES FORTIER MSW INTERN

MEDICARE:  MR. EDWARD JAMES FORTIER  MSW INTERN
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1548327521
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWARD JAMES FORTIER MSW INTERN
Provider Business Mailing Address
First Line : 9 ROATH ST
Second Line : APT 112
City : WORCESTER
State : MA
Zip : 01604-3178
Country : US
Telephone Number : 508-873-6332
Fax Number :
Provider Business Practice Location Address
First Line : 172 LINCOLN ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-3750
Country : US
Telephone Number : 508-770-0511
Fax Number : 508-770-0875
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/08/2007

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Directions to “ MR. EDWARD JAMES FORTIER MSW INTERN” Practice Location

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