Organization
CODMAN SQUARE HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAIQI TAO (CFO)
(617) 825-9660
Entity
Organization
Contact information
Practice address
637 WASHINGTON ST, DORCHESTER CENTER, MA 02124-3510
(617) 825-9660
Mailing address
637 WASHINGTON ST, DORCHESTER CENTER, MA 02124-3510
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1211757
—
MA
Enumeration date
06/11/2007
Last updated
08/22/2020
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