Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | S12078301 | MA |
NPI | 1003113812 |
---|---|
Provider Name | Brad N Tofias |
First Address | Canton, MA 02021-3401 |
Second Address | Canton, MA 02021-3401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2011 |
Last Update Date | 15/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XXH960503036 | BLUE CROSS BLUE SHIELD HMO BLUE (01) | MA |