Provider Demographics
NPI:1992915946
Name:MOITT, BERNADETTE M (LCSW)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:M
Last Name:MOITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-534-3134
Mailing Address - Fax:617-534-2611
Practice Address - Street 1:794 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2319
Practice Address - Country:US
Practice Address - Phone:617-534-6126
Practice Address - Fax:857-288-6658
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA20270221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid