Healthcare Provider Details

I. General information

NPI: 1235939927
Provider Name (Legal Business Name): BLUE CIRCLE HEALTH CLINICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 BROAD ST STE 14281
BOSTON MA
02109-4301
US

IV. Provider business mailing address

56 BROAD ST STE 14281
BOSTON MA
02109-4301
US

V. Phone/Fax

Practice location:
  • Phone: 888-404-4813
  • Fax: 888-675-4061
Mailing address:
  • Phone: 888-404-4813
  • Fax: 888-675-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUCESITA SCAMMON
Title or Position: PROGRAM MANAGER
Credential:
Phone: 413-213-2918