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Individual
BENJAMIN ROBERT TAVARES
Active
Individual
BENJAMIN ROBERT TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW136690
PA
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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