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General NPI Number Information
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NPI Number | 1124731476
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Entity Type | Organization
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Legal Business Name | REUNITED
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 1354 HANCOCK ST STE 205
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City | QUINCY
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State | MA
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Zip | 02169-5109
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Country | US
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Telephone | 857-939-4445
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Fax |
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Provider Business Mailing Address
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Address Line | 1354 HANCOCK ST STE 205
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City | QUINCY
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State | MA
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Zip | 02169-5109
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Country | US
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Telephone | 857-939-4445
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Fax |
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Authorized Official
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Title or Position | INTAKE COORDINATOR
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Name | BRANDON GHOLSON
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Credential | LCSW
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Telephone | 857-939-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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