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General NPI Number Information
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NPI Number | 1912752650
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Entity Type | Organization
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Legal Business Name | MERCURY BEHAVIORAL HEALTH OF MASSACHUSETTS PC
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 580 HARRISON AVE STE 2B
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City | BOSTON
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State | MA
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Zip | 02118-2440
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Country | US
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Telephone | 224-622-5470
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Fax | 919-910-5488
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Provider Business Mailing Address
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Address Line | 548 MARKET ST STE 17462
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-5401
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Country | US
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Telephone | 443-498-3972
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Fax | 919-910-5488
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Authorized Official
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Title or Position | CEO
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Name | ROBERT PAHLAVAN
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Credential |
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Telephone | 617-202-3565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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