Healthcare Provider Details

I. General information

NPI: 1700912656
Provider Name (Legal Business Name): SPECIALIZED HEALTH MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 KENDRICK ST STE 102
NEEDHAM MA
02494-2726
US

IV. Provider business mailing address

60 KENDRICK ST STE 102
NEEDHAM MA
02494-2726
US

V. Phone/Fax

Practice location:
  • Phone: 339-777-5446
  • Fax: 339-777-5447
Mailing address:
  • Phone: 339-777-5446
  • Fax: 339-777-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0498
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN38239
License Number StateME
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NANCY NAGER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 339-777-5446