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General NPI Number Information
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NPI Number | 1215321609
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Entity Type | Organization
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Legal Business Name | HALLMARK HEALTH
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 585 LEBANON ST
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City | MELROSE
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State | MA
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Zip | 02176-3225
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Country | US
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Telephone | 781-979-3756
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Fax |
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Provider Business Mailing Address
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Address Line | 178 SAVIN ST
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City | MALDEN
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State | MA
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Zip | 02148-2329
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Country | US
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Telephone | 781-306-6888
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SUSAN DOALDSON
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Credential | M.D.
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Telephone | 781-306-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 114759
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License Number State | MA
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