Healthcare Provider Details

I. General information

NPI: 1083338123
Provider Name (Legal Business Name): GAVREEL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GROSSMAN DR STE 205
BRAINTREE MA
02184-4947
US

IV. Provider business mailing address

150 GROSSMAN DR STE 205
BRAINTREE MA
02184-4947
US

V. Phone/Fax

Practice location:
  • Phone: 617-945-8655
  • Fax: 617-608-0674
Mailing address:
  • Phone: 617-945-8655
  • Fax: 617-608-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RICHARD W DE JESUS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 617-945-8655