Healthcare Provider Details

I. General information

NPI: 1649198763
Provider Name (Legal Business Name): MICHAEL DANA BORGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR STE 101D
BEVERLY MA
01915-6179
US

IV. Provider business mailing address

9462 SW 72ND CT
OCALA FL
34476-7094
US

V. Phone/Fax

Practice location:
  • Phone: 978-735-2320
  • Fax:
Mailing address:
  • Phone: 401-714-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: