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General NPI Number Information
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NPI Number | 1790211225
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Entity Type | Organization
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Legal Business Name | CITYPSYCH WELLNESS, INC.
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 333 LEE BURBANK HWY STE 2
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City | REVERE
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State | MA
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Zip | 02151-4003
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Country | US
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Telephone | 617-242-1000
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Fax | 617-242-1099
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Provider Business Mailing Address
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Address Line | 333 LEE BURBANK HWY STE 2
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City | REVERE
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State | MA
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Zip | 02151-4003
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Country | US
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Telephone | 617-242-1000
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Fax | 617-242-1099
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHLEEN HERAVI
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Credential | RN
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Telephone | 617-797-1746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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