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General NPI Number Information
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NPI Number | 1619491198
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Entity Type | Organization
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Legal Business Name | WILLETT & ASSOCIATES
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 22 ADAMS ST STE 1
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City | LYNN
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State | MA
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Zip | 01902-2804
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Country | US
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Telephone | 978-221-8652
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Fax |
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Provider Business Mailing Address
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Address Line | 22 ADAMS ST STE 1
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City | LYNN
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State | MA
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Zip | 01902-2804
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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 | CEO
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Name | JASON WILLETT
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Credential |
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Telephone | 978-221-8652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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