Healthcare Provider Details

I. General information

NPI: 1962833863
Provider Name (Legal Business Name): PUZZLE PIECES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1266 FURNACE BROOK PKWY STE 100B
QUINCY MA
02169-4789
US

IV. Provider business mailing address

1266 FURNACE BROOK PKWY STE 100B
QUINCY MA
02169-4789
US

V. Phone/Fax

Practice location:
  • Phone: 617-433-7699
  • Fax: 617-481-2325
Mailing address:
  • Phone: 617-433-7699
  • Fax: 617-481-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8546
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8947
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7307
License Number StateMA

VIII. Authorized Official

Name: MEGAN SHEA SELCHAN
Title or Position: CLINICAL DIRECTOR/PARTNER
Credential:
Phone: 617-890-1060