Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003207861 |
---|---|
Provider Name | Francisco Bastardo |
First Address | Malden, MA 02148-5906 |
Second Address | Malden, MA 02148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2015 |
Last Update Date | 16/02/2017 |