Healthcare Provider Details

I. General information

NPI: 1043837990
Provider Name (Legal Business Name): NANCY VILLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONCORD TPKE
CAMBRIDGE MA
02140
US

IV. Provider business mailing address

165 CAMBRIDGE PARK DR
CAMBRIDGE MA
02140
US

V. Phone/Fax

Practice location:
  • Phone: 978-729-0962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NANCY VILLA MEYERS
Title or Position: OWNER
Credential:
Phone: 978-729-0962