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NPI Code Detail

MEDICARE: PERSONAL INSIGHT THERAPY, LLC

MEDICARE: PERSONAL INSIGHT THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1114539467
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERSONAL INSIGHT THERAPY, LLC
Provider Business Mailing Address
First Line : 59 CUTTER ST
Second Line :
City : MELROSE
State : MA
Zip : 02176-3644
Country : US
Telephone Number : 617-406-8830
Fax Number :
Provider Business Practice Location Address
First Line : 226 LOWELL ST STE B7
Second Line :
City : WILMINGTON
State : MA
Zip : 01887-3073
Country : US
Telephone Number : 781-208-0558
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : JULIA VALIN NISS
Credential :
Telephone Number : 781-208-0558
Provider Enumeration Date : 08/18/2020
Last Update Date : 08/18/2020

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Directions to “PERSONAL INSIGHT THERAPY, LLC ” Practice Location

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