Individual
MS. JEANNIE MARIE BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
435 WARREN ST, ROXBURY, MA 02119-1833
(617) 442-7400
Mailing address
637 WASHINGTON ST, DORCHESTER, MA 02124-3510
(617) 825-9660
(617) 288-7898
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
119874
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110120605A
—
MA
Enumeration date
09/05/2012
Last updated
01/17/2024
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