Healthcare Provider Details

I. General information

NPI: 1841865565
Provider Name (Legal Business Name): BENNUCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 04/13/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BELMONT ST
BELMONT MA
02478-3603
US

IV. Provider business mailing address

51 PLEASANT ST # 82
MALDEN MA
02148-4904
US

V. Phone/Fax

Practice location:
  • Phone: 781-350-8553
  • Fax: 617-812-1692
Mailing address:
  • Phone: 781-350-8553
  • Fax: 617-812-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCUNE T CARRINGTON
Title or Position: OWNER
Credential: LICSW
Phone: 781-350-8553