Individual
ITATI VERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11 SYCAMORE ST, WORCESTER, MA 01608-2213
(508) 635-7436
Mailing address
19 SHATTUCK ST, WORCESTER, MA 01605-3603
(508) 635-7436
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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