1376758086 NPI number — UNIVERSITY HEALTH AND COUNSELING SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376758086 NPI number — UNIVERSITY HEALTH AND COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY HEALTH AND COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376758086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1170 WEST ST
Provider Second Line Business Mailing Address:
P.O. BOX 188
Provider Business Mailing Address City Name:
WALPOLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02081-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-668-5556
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 FORSYTH ST
Provider Second Line Business Practice Location Address:
360 HUNTINGTON AVENUE
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-373-2772
Provider Business Practice Location Address Fax Number:
617-373-2601
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
GAIRY
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
617-373-2772

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X , with the licence number:  163480 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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