Healthcare Provider Details

I. General information

NPI: 1801487632
Provider Name (Legal Business Name): M.O. L.I.F.E., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LAMBETH PARK DR
FAIRHAVEN MA
02719-4734
US

IV. Provider business mailing address

4 LAMBETH PARK DR
FAIRHAVEN MA
02719-4734
US

V. Phone/Fax

Practice location:
  • Phone: 508-992-5978
  • Fax:
Mailing address:
  • Phone: 508-992-5978
  • 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: IVAN BRITO
Title or Position: COO
Credential:
Phone: 774-263-8897