1861558694 NPI number — WOMEN'S MENTAL HEALTH COLLECTIVE, INC.

Table of content: (NPI 1861558694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861558694 NPI number — WOMEN'S MENTAL HEALTH COLLECTIVE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S MENTAL HEALTH COLLECTIVE, 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:
1861558694
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 UPLAND ROAD
Provider Second Line Business Mailing Address:
SUITE 2 CAMBRIDGE
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-354-6270
Provider Business Mailing Address Fax Number:
617-354-6275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 UPLAND ROAD
Provider Second Line Business Practice Location Address:
SUITE 2 CAMBRIDGE
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-354-6270
Provider Business Practice Location Address Fax Number:
617-354-6275
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COWETT
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
STAFF PSYCHOTHERAPIST
Authorized Official Telephone Number:
617-543-6270

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: W10433 . This is a "BLUE CROSS/BLUE SHIELD PS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 225010000 . This is a "MAGELLAN BEHAV. HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0300010 . This is a "HAVARD PILGRIM HEALTH CA." identifier . This identifiers is of the category "OTHER".
  • Identifier: P10224 . This is a "BLUE CROSS/BLUE SHIELD SO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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