Healthcare Provider Details

I. General information

NPI: 1245086321
Provider Name (Legal Business Name): SOMERVILLE-CAMBRIDGE ELDER SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MEDFORD ST STE 3
SOMERVILLE MA
02143-3422
US

IV. Provider business mailing address

61 MEDFORD ST STE 3
SOMERVILLE MA
02143-3422
US

V. Phone/Fax

Practice location:
  • Phone: 617-628-2601
  • Fax:
Mailing address:
  • Phone: 617-628-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DONNA VASKELIS
Title or Position: CFO
Credential:
Phone: 617-628-2601