Healthcare Provider Details

I. General information

NPI: 1700791936
Provider Name (Legal Business Name): 17 HEALERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MOUNT AUBURN ST STE 1
CAMBRIDGE MA
02138-5816
US

IV. Provider business mailing address

129 MOUNT AUBURN ST STE 1
CAMBRIDGE MA
02138-5816
US

V. Phone/Fax

Practice location:
  • Phone: 781-354-2102
  • Fax:
Mailing address:
  • Phone:
  • 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: LEON LATINO
Title or Position: PRE-LICENSED CLINICIAN
Credential:
Phone: 202-531-6221