MEDICARE: ANTONE D TAVEIRA MA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	1186	MA
2	164X00000X	Licensed Vocational Nurse	30347	MA
3	225C00000X	Rehabilitation Counselor	706	MA

General Provider Information

NPI Number	:	1932308210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONE D TAVEIRA MA

Provider Business Mailing Address
First Line	:	124 BULLOCK RD
Second Line	:
City	:	EAST FREETOWN
State	:	MA
Zip	:	02717-1416
Country	:	US
Telephone Number	:	508-763-5188
Fax Number	:	508-763-5188

Provider Business Practice Location Address
First Line	:	124 BULLOCK RD
Second Line	:
City	:	EAST FREETOWN
State	:	MA
Zip	:	02717-1416
Country	:	US
Telephone Number	:	508-763-5188
Fax Number	:	508-763-5188

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	07/16/2007

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