MEDICARE: MARTIN FRANCIS GUILFOY LADC I

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	13221	MA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	13221

General Provider Information

NPI Number	:	1457099178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN FRANCIS GUILFOY LADC I

Provider Business Mailing Address
First Line	:	29 WHITON AVE
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-7309
Country	:	US
Telephone Number	:	617-691-3632
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 WASHINGTON ST
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-7211
Country	:	US
Telephone Number	:	866-682-9355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	03/20/2025

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Directions to “ MARTIN FRANCIS GUILFOY LADC I” Practice Location

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