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101 Arch St Fl 8 Boston MA 02110-7500 | |
| (617) 872-3612 | |
| (617) 608-5968 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 101 Arch St Fl 8, Boston, Massachusetts |
| Authorized Official Name and Position | Penny Tavar (MANAGING DIRECTOR) |
| Authorized Official Contact | 6178723612 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 990001 Boston MA 02199-0001 Ph: (617) 872-3612 | 101 Arch St Fl 8 Boston MA 02110-7500 Ph: (617) 872-3612 |
| NPI Number | 1619602000 |
|---|---|
| Provider Enumeration Date | 07/19/2022 |
| Last Update Date | 04/05/2023 |
| Certification Date | 03/30/2023 |
| Medicare PECOS PAC ID | 5395112635 |
|---|---|
| Medicare Enrollment ID | O20221031000559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619602000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Penny A Tavar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053843318 PECOS PAC ID: 4880016104 Enrollment ID: I20221031000773 |
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