| Tage Lilja Licsw Llc | |
|
7 Harris Ave Ste 1b Boston MA 02130-2888 | |
| (802) 391-9865 | |
| Not Available |
| Full Name | Tage Lilja Licsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 7 Harris Ave Ste 1b, Boston, Massachusetts |
| Authorized Official Name and Position | Tage Lilja (SOLE MEMBER) |
| Authorized Official Contact | 8025562257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tage Lilja Licsw Llc Po Box 300138 Boston MA 02130-0002 Ph: () - | Tage Lilja Licsw Llc 7 Harris Ave Ste 1b Boston MA 02130-2888 Ph: (802) 391-9865 |
| NPI Number | 1205500329 |
|---|---|
| Provider Enumeration Date | 08/03/2021 |
| Last Update Date | 08/03/2021 |
| Certification Date | 07/29/2021 |
| Medicare PECOS PAC ID | 9032515499 |
|---|---|
| Medicare Enrollment ID | O20210909002960 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205500329 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tage Alan Lilja |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780827147 PECOS PAC ID: 9335488733 Enrollment ID: I20210909003059 |
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