Provider Demographics
NPI:1891587192
Name:JORGE, LEIDA PATRICIA MOREIRA TAV
Entity type:Individual
Prefix:
First Name:LEIDA
Middle Name:PATRICIA MOREIRA TAV
Last Name:JORGE
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 1:960 MASS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2693
Mailing Address - Country:US
Mailing Address - Phone:857-261-5820
Mailing Address - Fax:857-261-5820
Practice Address - Street 1:960 MASS AVE STE 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2693
Practice Address - Country:US
Practice Address - Phone:857-261-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator