MEDICARE: THE FAMILY WELLNESS CENTER, INC

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001307465	OTHER	MA	ID

General Provider Information

NPI Number	:	1730683004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE FAMILY WELLNESS CENTER, INC

Provider Business Mailing Address
First Line	:	220 FORBES RD STE 300
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-2714
Country	:	US
Telephone Number	:	781-519-6517
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 FORBES RD
Second Line	:
City	:	BRAINTREE
State	:	MA
Zip	:	02184-2705
Country	:	US
Telephone Number	:	781-519-6517
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CANDICE GRAVES
Credential	:	LICSW
Telephone Number	:	617-462-7796

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	08/18/2020

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