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General NPI Number Information
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NPI Number | 1518681147
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Entity Type | Organization
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Legal Business Name | BEACON HILL THERAPY, LLC
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 101 LARCH ROW
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City | WENHAM
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State | MA
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Zip | 01984-1623
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Country | US
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Telephone | 617-820-8105
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Fax |
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Provider Business Mailing Address
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Address Line | 101 LARCH ROW
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City | WENHAM
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State | MA
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Zip | 01984-1623
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Country | US
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Telephone | 617-820-8105
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEVLIN JACKSON
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Credential | PH.D.
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Telephone | 617-820-8105
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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 |
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License Number State |
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