Provider Demographics
NPI:1790383370
Name:INFANTE, EDUAL SR (CHW)
Entity Type:Individual
Prefix:
First Name:EDUAL
Middle Name:
Last Name:INFANTE
Suffix:SR
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LINDEN ST STE 208
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7916
Mailing Address - Country:US
Mailing Address - Phone:781-239-0290
Mailing Address - Fax:
Practice Address - Street 1:148 LINDEN ST STE 208
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7916
Practice Address - Country:US
Practice Address - Phone:781-239-0290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator