Healthcare Provider Details

I. General information

NPI: 1114107034
Provider Name (Legal Business Name): SEVENHILLS CLINICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 GRANT RD
DEVENS MA
01434-4468
US

IV. Provider business mailing address

22 GRANT RD
DEVENS MA
01434-4468
US

V. Phone/Fax

Practice location:
  • Phone: 978-772-7170
  • Fax: 978-772-7188
Mailing address:
  • Phone: 978-772-7170
  • Fax: 978-772-7188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number206970
License Number StateMA

VIII. Authorized Official

Name: MS. VALERIE VERONICA CHASE
Title or Position: ASST. VP
Credential: M.ED. CCC
Phone: 978-772-7170