MEDICARE: MRS. GRETCHEN HAZEN POWERS 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	110137	MA

General Provider Information

NPI Number	:	1952470379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRETCHEN HAZEN POWERS LICSW

Provider Business Mailing Address
First Line	:	168 CENTRAL ST
Second Line	:
City	:	HOLLISTON
State	:	MA
Zip	:	01746-2001
Country	:	US
Telephone Number	:	508-207-5495
Fax Number	:	508-429-6353

Provider Business Practice Location Address
First Line	:	118 WASHINGTON ST
Second Line	:
City	:	HOLLISTON
State	:	MA
Zip	:	01746-1373
Country	:	US
Telephone Number	:	508-207-5495
Fax Number	:	508-429-6353

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/09/2007

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