Healthcare Provider Details

I. General information

NPI: 1669879367
Provider Name (Legal Business Name): TRAUMA AND FAMILY INTEGRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 PRINCETON ST STE 307
NORTH CHELMSFORD MA
01863-1581
US

IV. Provider business mailing address

73 PRINCETON ST STE 307
NORTH CHELMSFORD MA
01863-1581
US

V. Phone/Fax

Practice location:
  • Phone: 978-677-7823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4C3D
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number4C3D
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. SAMUEL D ALEMAYHEU
Title or Position: ADMINISTRATOR/CLINICAL DIRECTOR
Credential:
Phone: 978-677-7823