Healthcare Provider Details

I. General information

NPI: 1417520370
Provider Name (Legal Business Name): A NEW LENS CONSULTANT & LIFE COACHING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EXCHANGE AVE
MEDFORD MA
02155-6309
US

IV. Provider business mailing address

4 EXCHANGE AVE
MEDFORD MA
02155-6309
US

V. Phone/Fax

Practice location:
  • Phone: 781-866-3191
  • Fax:
Mailing address:
  • Phone: 781-763-7724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CLAUDEL CHEVRY
Title or Position: CEO & PRESIDENT
Credential: MSW AND LIFE COACH
Phone: 781-866-3191