Healthcare Provider Details

I. General information

NPI: 1912752650
Provider Name (Legal Business Name): MERCURY BEHAVIORAL HEALTH OF MASSACHUSETTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 HARRISON AVE STE 2B
BOSTON MA
02118-2440
US

IV. Provider business mailing address

548 MARKET ST STE 17462
SAN FRANCISCO CA
94104-5401
US

V. Phone/Fax

Practice location:
  • Phone: 224-622-5470
  • Fax: 919-910-5488
Mailing address:
  • Phone: 443-498-3972
  • Fax: 919-910-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PAHLAVAN
Title or Position: CEO
Credential:
Phone: 617-202-3565