Healthcare Provider Details

I. General information

NPI: 1306555354
Provider Name (Legal Business Name): WITHIN HEALTH MA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CAMBRIDGEPARK DR STE 301
CAMBRIDGE MA
02140-2392
US

IV. Provider business mailing address

2665 S BAYSHORE DR STE 220
MIAMI FL
33133-5402
US

V. Phone/Fax

Practice location:
  • Phone: 866-918-2114
  • Fax:
Mailing address:
  • Phone: 866-918-2114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE STOCKERT
Title or Position: DIRECTOR OF HEALTH SERVICES AND QUA
Credential: RN
Phone: 305-725-2028