MEDICARE: MS. ANITA LEONE PARKER MSW

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	1023433	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PPO393	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1619972775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA LEONE PARKER MSW

Provider Business Mailing Address
First Line	:	PO BOX 245
Second Line	:
City	:	CUMMAQUID
State	:	MA
Zip	:	02637-0245
Country	:	US
Telephone Number	:	508-362-3878
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 HIGGINS CROWELL RD
Second Line	:
City	:	WEST YARMOUTH
State	:	MA
Zip	:	02673-3444
Country	:	US
Telephone Number	:	508-778-8580
Fax Number	:	508-778-8581

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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