Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 121629 | MA |
N | 104100000X | Social Worker | 121629 | MA |
Y | 1041C0700X | Clinical Social Worker | 121629 | MA |
N | 174V00000X | Clinical Ethicist | 121629 | MA |
NPI | 1023588209 |
---|---|
Provider Name | Meera Dave |
First Address | Cambridge, MA 02142-1334 |
Second Address | Brighton, MA 02135-2907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2018 |
Last Update Date | 29/11/2018 |