Healthcare Provider Details

I. General information

NPI: 1235637455
Provider Name (Legal Business Name): MICHELE ADAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 WATERTOWN ST # 3G
WATERTOWN MA
02472-2576
US

IV. Provider business mailing address

3 ARROWHEAD LN
BEVERLY MA
01915-1481
US

V. Phone/Fax

Practice location:
  • Phone: 978-712-0343
  • Fax:
Mailing address:
  • Phone: 978-808-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberRN227357
License Number StateMA

VIII. Authorized Official

Name: MICHELE ADAM
Title or Position: OWNER
Credential: NP
Phone: 978-712-0343