Healthcare Provider Details

I. General information

NPI: 1043811714
Provider Name (Legal Business Name): TIN HUANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2020
Last Update Date: 08/02/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 FURNACE BROOK PKWY STE 410
QUINCY MA
02169-4778
US

IV. Provider business mailing address

145 SOUTH ST
BOSTON MA
02111-2826
US

V. Phone/Fax

Practice location:
  • Phone: 737-990-2118
  • Fax:
Mailing address:
  • Phone: 737-990-2118
  • 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: