Healthcare Provider Details

I. General information

NPI: 1033586458
Provider Name (Legal Business Name): JULIE A CUMMINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PELHAM RD
LEXINGTON MA
02421-5707
US

IV. Provider business mailing address

13 PELHAM ROAD
LEXINGTON MA
02421
US

V. Phone/Fax

Practice location:
  • Phone: 781-274-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9261
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: