Healthcare Provider Details

I. General information

NPI: 1659857803
Provider Name (Legal Business Name): ALEXANDER RICHARD VLAVIANOS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX VLAVIANOS LMHC

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FENWAY
BOSTON MA
02115-5798
US

IV. Provider business mailing address

400 FENWAY
BOSTON MA
02115-5798
US

V. Phone/Fax

Practice location:
  • Phone: 617-735-9920
  • Fax: 617-735-9919
Mailing address:
  • Phone: 617-735-9920
  • Fax: 617-735-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10004432
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: