Healthcare Provider Details

I. General information

NPI: 1336862978
Provider Name (Legal Business Name): PHILLIP TRISCHITTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 CENTRAL ST
LOWELL MA
01852-2609
US

IV. Provider business mailing address

950 CAMBRIDGE ST
CAMBRIDGE MA
02141-1001
US

V. Phone/Fax

Practice location:
  • Phone: 978-674-6700
  • Fax:
Mailing address:
  • Phone: 617-441-1800
  • 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:
Title or Position:
Credential:
Phone: