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General NPI Number Information
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NPI Number | 1013779800
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Entity Type | Organization
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Legal Business Name | FAMILY INTERVENTION TEAM FIT LLC
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 1534 TREMONT ST
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City | ROXBURY CROSSING
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State | MA
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Zip | 02120-2929
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Country | US
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Telephone | 781-330-9357
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Fax |
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Provider Business Mailing Address
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Address Line | 23 REYEM ST
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City | WALTHAM
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State | MA
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Zip | 02453-5401
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Country | US
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Telephone | 781-330-9357
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. ROSCOE GORHAM JR.
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Credential | LICSW
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Telephone | 781-330-9357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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