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General NPI Number Information
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NPI Number | 1740769728
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Entity Type | Organization
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Legal Business Name | BAYON MEDICAL GROUP LLC
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Dates
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Enumeration Date | 08/09/2018
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 280 UNION ST STE 402
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City | LYNN
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State | MA
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Zip | 01901-1353
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Country | US
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Telephone | 857-452-6356
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Fax | 888-390-9437
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Provider Business Mailing Address
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Address Line | 280 UNION ST STE 402
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City | LYNN
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State | MA
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Zip | 01901-1353
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Country | US
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Telephone | 857-452-6356
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Fax | 888-390-9437
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | VLADIMIR BATRIN
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Credential | MS
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Telephone | 857-452-6356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5297
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License Number State | MA
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