Healthcare Provider Details

I. General information

NPI: 1801067541
Provider Name (Legal Business Name): HARVAND VANGUARD MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 DARTMOUTH ST BEHAVIORAL HEALTH DEPT
BOSTON MA
02116-5123
US

IV. Provider business mailing address

275 GROVE ST SUITE 3-300
AUBURNDALE MA
02466-2272
US

V. Phone/Fax

Practice location:
  • Phone: 617-559-8374
  • Fax: 617-421-3487
Mailing address:
  • Phone: 617-559-8374
  • Fax: 617-421-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: H. EUGENE LINDSEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 617-559-8374