MEDICARE: KRISTIN WILSON TAYLOR 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	MA111382	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0300010	OTHER	MA	VALUE OPTIONS
2	P10283	OTHER	MA	BCBS
3	0300010	OTHER	MD	MBHP
4	MA111382	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1942256805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN WILSON TAYLOR LICSW

Provider Business Mailing Address
First Line	:	55 WAREHAM ST
Second Line	:
City	:	CARVER
State	:	MA
Zip	:	02330-1716
Country	:	US
Telephone Number	:	508-280-4825
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 WAREHAM ST
Second Line	:
City	:	CARVER
State	:	MA
Zip	:	02330-1716
Country	:	US
Telephone Number	:	508-280-4825
Fax Number	:

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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