Most Relevant Information
Provider Data
| NPI Number: | 1003335464 |
| Provider Name: | EBONEE TROUP BS |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | INTERN |
Most Important Dates
| Enumeration Date: | 09/15/2017 |
| Last Updated: | 09/15/2017 |
Provider Practice Location
520 DUDLEY ST
ROXBURY
MA
021192769
Practice Location Phone/Fax
| Phone: | 6176909701 |
| Fax: |
Provider Mailing Location
520 DUDLEY ST
ROXBURY
MA
021192769
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |