Individual
BENJAMIN ROBERT TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
4725 CHESTER AVE APT B2, PHILADELPHIA, PA 19143-3532
(978) 380-2876
Mailing address
4725 CHESTER AVE APT B2, PHILADELPHIA, PA 19143-3532
(978) 380-2876
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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