Provider Demographics
NPI:1700988805
Name:TRAFAS, TERESE J (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:TERESE
Middle Name:J
Last Name:TRAFAS
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 KINNAIRD ST
Mailing Address - Street 2:STE B
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:617-661-2965
Mailing Address - Fax:617-491-6080
Practice Address - Street 1:1 W FOSTER ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3847
Practice Address - Country:US
Practice Address - Phone:617-661-2965
Practice Address - Fax:617-491-6080
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10224561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAZ44018000OtherMAGELLAN
MAP06586OtherBLUE CROSS BLUE SHIELD OF
MA1852272Medicaid
MAP30061Medicare ID - Type Unspecified