Healthcare Provider Details

I. General information

NPI: 1063217842
Provider Name (Legal Business Name): EMERGENCE HEALTH & WELLNESS FOR MEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MARBLE ST APT 301E
WHITMAN MA
02382-2485
US

IV. Provider business mailing address

125 CHURCH ST UNIT 90-144
PEMBROKE MA
02359-1991
US

V. Phone/Fax

Practice location:
  • Phone: 617-669-4443
  • Fax:
Mailing address:
  • Phone: 781-499-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. SEAN PATRICK DUGGAN
Title or Position: OWNER
Credential: LICSW
Phone: 781-499-2197