Mr. Antonio J Wideman, PEER SPECIALIST
Peer Specialist in Mattapan, Massachusetts
1932835238- Practice location
- 884 Cummins Hwy Apt 4, Mattapan, MA 02126-2043
- Phone
- 617-691-6034
- Fax
- —
- Last updated
- July 28, 2022
Antonio Jamaal Wideman is a Peer Specialist based in Mattapan, MA. Antonio Jamaal Wideman practices in Mattapan, MA and has the professional credentials of PEER SPECIALIST. The NPI Number for Antonio Jamaal Wideman is 1932835238 and holds a License No. 202222 (MA). The current practice location address for Antonio Jamaal Wideman is 884 Cummins Hwy Apt 4, Mattapan, MA 02126-2043 and can be reached out via phone at 617-691-6034.
Provider Profile Details
- NPI Number
- 1932835238
- Provider Name
- Antonio Jamaal Wideman
- Credential
- PEER SPECIALIST
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 884 Cummins Hwy Apt 4, Mattapan, MA 02126-2043
- Phone Number
- 617-691-6034
- Primary Taxonomy
- Peer Specialist · 175T00000X
- Sole Proprietor
- Yes
- Provider Enumeration Date
- July 28, 2022
- Last Update Date
- July 28, 2022
- Certification Date
- July 28, 2022
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 884 Cummins Hwy Apt 4
Mattapan, MA 02126-2043 - City
- Mattapan
- State
- Massachusetts
- Zip
- 02126-2043
- Phone Number
- 617-691-6034
Provider Business Mailing Address Details
- Address
- 884 Cummins Hwy Apt 4
Mattapan, MA 02126-2043 - City
- Mattapan
- State
- MA
- Zip
- 02126-2043
- Phone Number
- 617-691-6034
License Information
- License Number
- 202222
- License State
- MA
- Taxonomy
- Peer Specialist · 175T00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Mr. Antonio J Wideman, PEER SPECIALIST?
The NPI number of Mr. Antonio J Wideman, PEER SPECIALIST is 1932835238. It was assigned on July 28, 2022 and is currently active in the NPPES registry.
What is the specialty of Mr. Antonio J Wideman, PEER SPECIALIST?
Mr. Antonio J Wideman, PEER SPECIALIST is registered under the primary taxonomy Peer Specialist (code 175T00000X), licensed in MA under license number 202222.
Where does Mr. Antonio J Wideman, PEER SPECIALIST practice?
The practice location is 884 Cummins Hwy Apt 4, Mattapan, MA 02126-2043. The office can be reached at 617-691-6034 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1932835238 directly on the NPPES registry website.