Healthcare Provider Details

I. General information

NPI: 1972006104
Provider Name (Legal Business Name): ATHINA-ELENI G. MAVROUDHIS, LMHC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 HIGH ST
WESTWOOD MA
02090-2737
US

IV. Provider business mailing address

1188 HIGH ST
WESTWOOD MA
02090-2737
US

V. Phone/Fax

Practice location:
  • Phone: 781-690-6635
  • Fax: 617-249-0333
Mailing address:
  • Phone: 781-690-6635
  • Fax: 617-249-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6639
License Number StateMA

VIII. Authorized Official

Name: ATHINA-ELENI GOUDANAS MAVROUDHIS
Title or Position: PRESIDENT/CLINICIAN
Credential:
Phone: 781-690-6635