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General NPI Number Information
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NPI Number | 1487510830
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Entity Type | Organization
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Legal Business Name | CITYWIDE BEHAVIORAL HEALTH INC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 135 WEBSTER ST STE 1
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City | HANOVER
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State | MA
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Zip | 02339-1200
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Country | US
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Telephone | 781-429-7755
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Fax |
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Provider Business Mailing Address
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Address Line | 25 SIMPSON ST
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City | NEWTON
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State | MA
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Zip | 02458-2225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SLAVA ISMINTSEV
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Credential |
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Telephone | 617-699-5845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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