Healthcare Provider Details

I. General information

NPI: 1144954124
Provider Name (Legal Business Name): MENTAL AWARENESS FOR ALL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 N MAIN ST
RANDOLPH MA
02368-3005
US

IV. Provider business mailing address

1269 HYDE PARK AVE UNIT 365775
HYDE PARK MA
02136-5838
US

V. Phone/Fax

Practice location:
  • Phone: 857-294-2958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANN-MARIE DENTON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 857-294-2958