Provider Demographics
NPI:1699253567
Name:LOVETT, CORDELIA BROOKE
Entity type:Individual
Prefix:MS
First Name:CORDELIA
Middle Name:BROOKE
Last Name:LOVETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COLUMBIAN ST
Mailing Address - Street 2:
Mailing Address - City:S WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1601
Mailing Address - Country:US
Mailing Address - Phone:781-624-4791
Mailing Address - Fax:
Practice Address - Street 1:101 COLUMBIAN ST
Practice Address - Street 2:
Practice Address - City:S WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1601
Practice Address - Country:US
Practice Address - Phone:781-624-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1032477104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker