Provider Demographics
NPI:1922405232
Name:LUZ STELLA LOAIZA
Entity Type:Organization
Organization Name:LUZ STELLA LOAIZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:STELLA
Authorized Official - Last Name:LOAIZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:617-637-5250
Mailing Address - Street 1:47 PHEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3011
Mailing Address - Country:US
Mailing Address - Phone:617-637-5250
Mailing Address - Fax:
Practice Address - Street 1:47 PHEASANT ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-3011
Practice Address - Country:US
Practice Address - Phone:617-637-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS37025870302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization