Provider Demographics
NPI:1851497655
Name:PASSARO, STEPHANIE FELICIA (LICSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:FELICIA
Last Name:PASSARO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BOSTON MEDICAL CTR PL
Mailing Address - Street 2:PEDIATRIC EMERGENCY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2908
Mailing Address - Country:US
Mailing Address - Phone:617-414-5007
Mailing Address - Fax:617-414-5018
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:PEDIATRIC EMERGENCY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-5007
Practice Address - Fax:617-414-5018
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111737104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker