Most Relevant Information
Provider Data
| NPI Number: | 1003329095 |
| Provider Name: | JACQUELINE BANGO LICSW |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | 120046 |
Most Important Dates
| Enumeration Date: | 11/13/2017 |
| Last Updated: | 11/13/2017 |
Provider Practice Location
55 FRUIT STREET
FOUNDERS BUILDING SUITE 880
BOSTON
MA
02114
Practice Location Phone/Fax
| Phone: | 6176438281 |
| Fax: |
Provider Mailing Location
35 N MARGIN ST APT 2
BOSTON
MA
021131638
Provider Mailing Phone/Fax
| Phone: | 2037107732 |
| Fax: |