Healthcare Provider Details

I. General information

NPI: 1619009784
Provider Name (Legal Business Name): THE GUIDANCE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MEDFORD ST
SOMERVILLE MA
02143-3429
US

IV. Provider business mailing address

5 SACRAMENTO ST
CAMBRIDGE MA
02138-1812
US

V. Phone/Fax

Practice location:
  • Phone: 617-629-3919
  • Fax: 617-629-4644
Mailing address:
  • Phone: 617-354-2275
  • Fax: 617-547-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN AYERS
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 617-354-2275