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General NPI Number Information
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NPI Number | 1477377539
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Entity Type | Organization
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Legal Business Name | STARLIGHT BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 400 W CUMMINGS PARK STE 6100
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City | WOBURN
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State | MA
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Zip | 01801-6512
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Country | US
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Telephone | 781-799-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 64 MAIN ST APT 35B
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City | STONEHAM
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State | MA
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Zip | 02180-3384
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Country | US
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Telephone | 781-799-8775
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KENNEDY TAMBI
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Credential |
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Telephone | 781-799-8775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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