1699807842 NPI number — THE GUIDANCE CENTER, INC.

Table of content: VINCENT MICHAEL NICCHI MD (NPI 1467031492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699807842 NPI number — THE GUIDANCE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GUIDANCE CENTER, INC.
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:
6
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:
1699807842
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:
5 SACRAMENTO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02138-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-354-2275
Provider Business Mailing Address Fax Number:
617-547-4356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 SACRAMENTO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-354-2275
Provider Business Practice Location Address Fax Number:
617-547-4356
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AYERS
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
617-354-2275

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1000870 . This is a "MHSPY NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18498 . This is a "BCBS MEDEX" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 260453 . This is a "BCBS MAGELLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1301276 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 721991 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 996270 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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