MEDICARE: MS. PAULINA MARIE HEYWOOD 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
1	1041C0700X	Clinical Social Worker	1017966	MA

General Provider Information

NPI Number	:	1609950336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULINA MARIE HEYWOOD MSW/LICSW

Provider Business Mailing Address
First Line	:	55 DIMOCK ST
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-1029
Country	:	US
Telephone Number	:	617-442-8800
Fax Number	:	617-541-8622

Provider Business Practice Location Address
First Line	:	55 DIMOCK ST
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-1029
Country	:	US
Telephone Number	:	617-442-8800
Fax Number	:	617-541-8622

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	10/05/2007

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