=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861048308
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HENRY ANNE VELYSIA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2019
-----------------------------------------------------
Last Update Date | 08/12/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HOSPITAL DRIVE SULLIVAN 5
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-934-8520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 491 DUTTON ST UNIT 315
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01854-4290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-905-5180
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 222399
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------