Individual
MR. ANTONIO JAMAAL WIDEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PEER SPECIALIST
Contact information
Practice address
884 CUMMINS HWY APT 4, MATTAPAN, MA 02126-2043
(617) 691-6034
Mailing address
884 CUMMINS HWY APT 4, MATTAPAN, MA 02126-2043
(617) 691-6034
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
202222
MA
Other
Enumeration date
07/28/2022
Last updated
07/28/2022
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