Individual provider · Type 1 NPI

Tahira Lodge, PhD

Mental Health Counselor · Jamaica Plain, MA

NPI number 1245822113 Active

Practice location

49 Robinwood Ave
Jamaica Plain, MA 02130-2156

Fax (617) 390-1595

Mailing address

76 Willowwood St
Dorchester, MA 02124-4030

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800X7139 (MA)

Mental Health Counselor: Definition to come...

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About NPI 1245822113

Tahira Lodge, PhD's National Provider Identifier is 1245822113, issued on Feb 11, 2021. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Jamaica Plain, MA. The record was last updated on Feb 11, 2021.