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General NPI Number Information
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NPI Number | 1235637455
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Entity Type | Organization
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Legal Business Name | MICHELE ADAM LLC
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 124 WATERTOWN ST # 3G
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City | WATERTOWN
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State | MA
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Zip | 02472-2576
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Country | US
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Telephone | 978-712-0343
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Fax |
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Provider Business Mailing Address
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Address Line | 3 ARROWHEAD LN
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City | BEVERLY
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State | MA
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Zip | 01915-1481
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Country | US
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Telephone | 978-808-4648
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELE ADAM
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Credential | NP
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Telephone | 978-712-0343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | RN227357
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License Number State | MA
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