Healthcare Provider Details

I. General information

NPI: 1326972837
Provider Name (Legal Business Name): MAB COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 IVY ST
BROOKLINE MA
02446-3907
US

IV. Provider business mailing address

29 DENBY RD
ALLSTON MA
02134-1605
US

V. Phone/Fax

Practice location:
  • Phone: 617-738-5110
  • Fax: 774-366-0610
Mailing address:
  • Phone: 617-738-5110
  • Fax: 774-366-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL PANICOLA
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 617-732-0238