Provider Demographics
NPI:1972086163
Name:BAIZERMAN, TASHA NICOLE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:TASHA
Middle Name:NICOLE
Last Name:BAIZERMAN
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 1:62 EVERETT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2104
Mailing Address - Country:US
Mailing Address - Phone:339-222-2428
Mailing Address - Fax:
Practice Address - Street 1:396 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3502
Practice Address - Country:US
Practice Address - Phone:617-635-9832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1152711041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty