Healthcare Provider Details

I. General information

NPI: 1649886912
Provider Name (Legal Business Name): HALEY ANNE VRADENBURG LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 WASHINGTON ST
BRAINTREE MA
02184-7599
US

IV. Provider business mailing address

91 OAKLAND AVE
QUINCY MA
02170-3738
US

V. Phone/Fax

Practice location:
  • Phone: 857-344-4394
  • Fax:
Mailing address:
  • Phone: 781-296-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10005380
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: