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General NPI Number Information
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NPI Number | 1538819909
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Entity Type | Organization
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Legal Business Name | LUMIN HEALTH PG
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 10 LANGLEY RD STE 200
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City | NEWTON
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State | MA
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Zip | 02459-1972
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Country | US
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Telephone | 617-863-8810
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Fax | 617-863-8844
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Provider Business Mailing Address
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Address Line | 10 LANGLEY RD STE 200
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City | NEWTON
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State | MA
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Zip | 02459-1972
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Country | US
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Telephone | 617-863-8810
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Fax | 617-863-8844
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN LOUIS YUDKOFF
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Credential | MD
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Telephone | 201-953-0432
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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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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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