Healthcare Provider Details

I. General information

NPI: 1891578258
Provider Name (Legal Business Name): QIUYUAN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BROADWAY
CHELSEA MA
02150-2807
US

IV. Provider business mailing address

301 BROADWAY
CHELSEA MA
02150-2807
US

V. Phone/Fax

Practice location:
  • Phone: 617-889-4860
  • 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:
Title or Position:
Credential:
Phone: