MEDICARE: MS. ARACELI M ISENIA 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	110253	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P07819	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1679548754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ARACELI M ISENIA LICSW

Provider Business Mailing Address
First Line	:	875 MASSACHUSETTS AVE
Second Line	:	SUITE 82
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3067
Country	:	US
Telephone Number	:	617-253-9872
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 MASSACHUSETTS AVE
Second Line	:	SUITE 82
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3067
Country	:	US
Telephone Number	:	617-253-9872
Fax Number	:

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/10/2007

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