MEDICARE: JOURNEYS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1538743430	OTHER	MA	NPI

General Provider Information

NPI Number	:	1275254039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEYS

Provider Business Mailing Address
First Line	:	32 TYLER RD
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-2426
Country	:	US
Telephone Number	:	503-720-8336
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 MASSACHUSETTS AVE STE 3A
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-5322
Country	:	US
Telephone Number	:	781-472-0341
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	LISA C VAN OOSSANEN
Credential	:	LICSW
Telephone Number	:	503-720-8336

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	09/08/2022

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Directions to “JOURNEYS ” Practice Location

Language	Start Address	Practice Location

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