Basic Information
| Provider Information | |||||||||
| NPI: | 1598095010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LLANO | ||||||||
| FirstName: | FELISE | ||||||||
| MiddleName: | LUISE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LISCW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 CITY HALL MALL | ||||||||
| Address2: | HARVARD VANGUARD MEDICAL ASSOCIATES | ||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021554754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813065463 | ||||||||
| FaxNumber: | 7813065015 | ||||||||
| Practice Location | |||||||||
| Address1: | 26 CITY HALL MALL | ||||||||
| Address2: | HARVARD VANGUARD MEDICAL ASSOCIATES | ||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021554754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813065463 | ||||||||
| FaxNumber: | 7813065015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2010 | ||||||||
| LastUpdateDate: | 01/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 106639 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.