Healthcare Provider Details

I. General information

NPI: 1710690565
Provider Name (Legal Business Name): JOURNEY PSYCHIATRIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2022
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 SOMERVILLE AVE # 337
SOMERVILLE MA
02143-3347
US

IV. Provider business mailing address

519 SOMERVILLE AVE # 337
SOMERVILLE MA
02143-3347
US

V. Phone/Fax

Practice location:
  • Phone: 781-630-0198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH LAVOIE
Title or Position: OWNER
Credential: APRN
Phone: 781-630-0198