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General NPI Number Information
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NPI Number | 1356257737
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Entity Type | Individual
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Provider Name | MARK ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 08/24/2026
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 125 HARTWELL AVE
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City | LEXINGTON
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State | MA
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Zip | 02421-3100
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Country | US
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Telephone | 781-861-0890
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Fax |
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Provider Business Mailing Address
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Address Line | 400 QUANNAPOWITT PKWY APT 4238
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City | WAKEFIELD
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State | MA
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Zip | 01880-1369
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Country | US
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Telephone | 203-623-3972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8339
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License Number State | CT
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