1497951354 NPI number — ANAM CARA COUNSELING SVCS

Table of content: (NPI 1497951354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497951354 NPI number — ANAM CARA COUNSELING SVCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANAM CARA COUNSELING SVCS
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:
1497951354
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:
424 ADAMS ST
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02186-4358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-970-4472
Provider Business Mailing Address Fax Number:
617-696-1644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 VINEWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02186-4838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-970-4472
Provider Business Practice Location Address Fax Number:
617-696-1644
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-970-4472

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  173162 , 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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