Healthcare Provider Details

I. General information

NPI: 1801791918
Provider Name (Legal Business Name): JUSTINE RESOURCE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 UNION ST
LAWRENCE MA
01840-1866
US

IV. Provider business mailing address

15 UNION ST
LAWRENCE MA
01840-1866
US

V. Phone/Fax

Practice location:
  • Phone: 508-413-7964
  • Fax: 978-256-6049
Mailing address:
  • Phone: 508-413-7964
  • Fax: 978-686-2954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DENNIS EDWARD HAJJAR I
Title or Position: THERAPEUTIC MENTOR
Credential: BS
Phone: 508-413-7964