Healthcare Provider Details

I. General information

NPI: 1619498748
Provider Name (Legal Business Name): FAITH DANIELLE JUSTYNSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 WILLARD ST STE 430
QUINCY MA
02169-7490
US

IV. Provider business mailing address

859 WILLARD ST STE 430
QUINCY MA
02169-7490
US

V. Phone/Fax

Practice location:
  • Phone: 617-847-1950
  • Fax: 617-774-1490
Mailing address:
  • Phone: 617-847-1950
  • Fax: 617-774-1490

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: