Healthcare Provider Details

I. General information

NPI: 1740261437
Provider Name (Legal Business Name): PSYCHIATRIC ASSOCIATES OF LYNN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 REVERE BEACH BLVD
REVERE MA
02151-4866
US

IV. Provider business mailing address

350 REVERE BEACH BLVRD APT.# 9-10P
REVERE MA
02151-4866
US

V. Phone/Fax

Practice location:
  • Phone: 781-286-5619
  • Fax:
Mailing address:
  • Phone: 781-286-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number210779
License Number StateMA

VIII. Authorized Official

Name: ALEXANDER LIPIN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 781-268-2200