Healthcare Provider Details

I. General information

NPI: 1336283480
Provider Name (Legal Business Name): MAY H ATKINS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 FAYERWEATHER STREET #1
CAMBRIDGE MA
02138-0000
US

IV. Provider business mailing address

165 FAYERWEATHER STREET #1
CAMBRIDGE MA
02138-0000
US

V. Phone/Fax

Practice location:
  • Phone: 615-579-3890
  • Fax: 615-269-7322
Mailing address:
  • Phone: 615-579-3890
  • Fax: 615-269-7322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLSW0000003086
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number119037
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: