Healthcare Provider Details

I. General information

NPI: 1770438624
Provider Name (Legal Business Name): THE CHILD AND FAMILY WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/15/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 HYDE PARK AVE
HYDE PARK MA
02136-2819
US

IV. Provider business mailing address

1234 HYDE PARK AVE
HYDE PARK MA
02136-2819
US

V. Phone/Fax

Practice location:
  • Phone: 888-763-7272
  • Fax: 877-243-2959
Mailing address:
  • Phone: 888-763-7272
  • Fax: 877-243-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW ALEXANDER LEZAMA
Title or Position: COUNSELOR
Credential: MA
Phone: 888-763-7272