Healthcare Provider Details

I. General information

NPI: 1891629150
Provider Name (Legal Business Name): AVA VALENTINE HUMPHREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 FORBES RD STE 207
BRAINTREE MA
02184-2720
US

IV. Provider business mailing address

30 DALTON ST APT 902
BOSTON MA
02115-3175
US

V. Phone/Fax

Practice location:
  • Phone: 917-868-4118
  • Fax:
Mailing address:
  • Phone: 917-868-4118
  • Fax:

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: