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NPI Code Detail

MEDICARE: MR. LUIS O BARBOSA

MEDICARE: MR. LUIS O BARBOSA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1568636769
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LUIS O BARBOSA
Provider Business Mailing Address
First Line : 687 WASHINGTON AVE
Second Line :
City : REVERE
State : MA
Zip : 02151-1928
Country : US
Telephone Number : 617-240-9981
Fax Number :
Provider Business Practice Location Address
First Line : 205 PORTLAND ST
Second Line :
City : BOSTON
State : MA
Zip : 02114-1721
Country : US
Telephone Number : 617-523-2214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2008
Last Update Date : 04/17/2008

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Directions to “ MR. LUIS O BARBOSA ” Practice Location

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