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NPI Code Detail

MEDICARE: MS. ANGELA MARIE FONSECA LADCI CAS

MEDICARE:  MS. ANGELA MARIE FONSECA  LADCI  CAS
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
1324500000XSubstance Abuse Rehabilitation FacilityMA

General Provider Information

NPI Number : 1750668539
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELA MARIE FONSECA LADCI CAS
Provider Business Mailing Address
First Line : 618 TWIN LAKES DR
Second Line :
City : HALIFAX
State : MA
Zip : 02338-2229
Country : US
Telephone Number : 781-294-4123
Fax Number :
Provider Business Practice Location Address
First Line : 62 WALDECK ST
Second Line :
City : DORCHESTER CENTER
State : MA
Zip : 02124-1329
Country : US
Telephone Number : 617-265-2636
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2011
Last Update Date : 11/08/2011

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Directions to “ MS. ANGELA MARIE FONSECA LADCI CAS” Practice Location

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