Healthcare Provider Details

I. General information

NPI: 1700718921
Provider Name (Legal Business Name): CLEAR HARBOR HEALING AND EMPOWERMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 CANAL ST
SOMERVILLE MA
02145-4347
US

IV. Provider business mailing address

449 CANAL ST APT 1104
SOMERVILLE MA
02145-4375
US

V. Phone/Fax

Practice location:
  • Phone: 224-418-9993
  • Fax:
Mailing address:
  • Phone: 224-418-9993
  • 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: JIHAN QU
Title or Position: FOUNDER & EXECUTIVE DIRECTOR
Credential:
Phone: 224-418-9993