Healthcare Provider Details

I. General information

NPI: 1841509809
Provider Name (Legal Business Name): JUSTIN TOWNE MSMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STANIFORD ST
BOSTON MA
02114-2503
US

IV. Provider business mailing address

25 STANIFORD ST
BOSTON MA
02114-2503
US

V. Phone/Fax

Practice location:
  • Phone: 617-523-1529
  • Fax: 617-523-1207
Mailing address:
  • Phone: 617-523-1529
  • Fax: 617-523-1207

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: