MEDICARE: MICHELLE PERNINI

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	120897	MA

General Provider Information

NPI Number	:	1821577495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE PERNINI

Provider Business Mailing Address
First Line	:	177 HUNTINGTON AVE FL 14
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-3134
Country	:	US
Telephone Number	:	888-572-0795
Fax Number	:	978-496-8771

Provider Business Practice Location Address
First Line	:	177 HUNTINGTON AVE FL 14
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-3134
Country	:	US
Telephone Number	:	888-572-0795
Fax Number	:	978-496-8771

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

Provider Enumeration Date	:	08/14/2018
Last Update Date	:	04/01/2025

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Directions to “ MICHELLE PERNINI ” Practice Location

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