Healthcare Provider Details

I. General information

NPI: 1992233563
Provider Name (Legal Business Name): LEMUEL VASSAR MILLS JR. MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 BLUE HILL AVE
BOSTON MA
02121-4302
US

IV. Provider business mailing address

35 BRADLEE ST
HYDE PARK MA
02136-3205
US

V. Phone/Fax

Practice location:
  • Phone: 617-541-6859
  • Fax: 617-445-2125
Mailing address:
  • Phone: 617-792-4906
  • Fax: 617-541-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number467450
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: