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General NPI Number Information
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NPI Number | 1316398852
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Entity Type | Organization
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Legal Business Name | DEARBORN WELLNESS, LLC
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1266 FURNACE BROOK PKWY STE 307
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City | QUINCY
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State | MA
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Zip | 02169-4789
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Country | US
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Telephone | 857-288-8508
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Fax | 888-262-9456
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Provider Business Mailing Address
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Address Line | 1266 FURNACE BROOK PKWY STE 307
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City | QUINCY
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State | MA
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Zip | 02169-4789
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Country | US
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Telephone | 857-288-8508
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Fax | 888-262-9456
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. KATHERINE KING
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Credential | PSYD
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Telephone | 857-288-8508
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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 | 9599
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License Number State | MA
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