Mr. Antonio Jamaal Wideman, PEERSPECIALIST
Mr. Antonio Jamaal Wideman, PEERSPECIALIST is a Peer Specialist in Mattapan, Massachusetts. Practices as a sole proprietor. Licensed in Massachusetts.
- Licensed in
- MA
- In the registry since
- 2022
Practice location Address checks out
884 Cummins Hwy Apt 4Mattapan, MA 02126-2043
Phone: (617) 691-6034
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Peer Specialist (primary) | Taxonomy 175T00000X · Licence 202222 (MA) |
|---|
Record details
| NPI number | 1932835238 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Credentials | PEERSPECIALIST |
| Sole proprietor | Yes |
| NPI enumerated | July 28, 2022 |
| Last updated in NPPES | July 28, 2022 |
| Certification date | July 28, 2022 |