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General NPI Number Information
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NPI Number | 1972006104
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Entity Type | Organization
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Legal Business Name | ATHINA-ELENI G. MAVROUDHIS, LMHC, INC.
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 23 WIGHT ST
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City | WALTHAM
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State | MA
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Zip | 02452-7941
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Country | US
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Telephone | 781-690-6635
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Fax | 978-313-8209
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Provider Business Mailing Address
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Address Line | 23 WIGHT ST
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City | WALTHAM
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State | MA
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Zip | 02452-7941
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Country | US
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Telephone | 781-690-6635
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Fax | 978-313-8209
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Authorized Official
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Title or Position | PRESIDENT/CLINICIAN
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Name | MS. ATHINA-ELENI GOUDANAS MAVROUDHIS
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Credential | LMHC
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Telephone | 781-690-6635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6639
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License Number State | MA
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