Provider Demographics
NPI:1932308210
Name:TAVEIRA, ANTONE D (MA)
Entity Type:Individual
Prefix:
First Name:ANTONE
Middle Name:D
Last Name:TAVEIRA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BULLOCK RD
Mailing Address - Street 2:
Mailing Address - City:EAST FREETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02717-1416
Mailing Address - Country:US
Mailing Address - Phone:508-763-5188
Mailing Address - Fax:508-763-5188
Practice Address - Street 1:124 BULLOCK RD
Practice Address - Street 2:
Practice Address - City:EAST FREETOWN
Practice Address - State:MA
Practice Address - Zip Code:02717-1416
Practice Address - Country:US
Practice Address - Phone:508-763-5188
Practice Address - Fax:508-763-5188
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1186101YA0400X
MA30347164X00000X
MA706225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor