Provider Demographics
NPI:1528586625
Name:CHAPA CERVIATTI, PAOLA G (LICSW)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:G
Last Name:CHAPA CERVIATTI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PAOLA
Other - Middle Name:G
Other - Last Name:CHAPA CERVIATTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAOLA CHAPACERVIATTI
Mailing Address - Street 1:780 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2755
Mailing Address - Country:US
Mailing Address - Phone:857-654-1000
Mailing Address - Fax:857-654-1100
Practice Address - Street 1:780 ALBANY ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2755
Practice Address - Country:US
Practice Address - Phone:857-654-1000
Practice Address - Fax:857-654-1100
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001233201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical