MEDICARE: THE E3 FOUNDATION INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1790563666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE E3 FOUNDATION INC.

Provider Business Mailing Address
First Line	:	9 BARTLET ST STE 242
Second Line	:
City	:	ANDOVER
State	:	MA
Zip	:	01810-3655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1116 20TH ST S STE 510
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-2612
Country	:	US
Telephone Number	:	978-228-5085
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. MICHAEL RAPP JR.
Credential	:
Telephone Number	:	978-228-5085

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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Directions to “THE E3 FOUNDATION INC. ” Practice Location

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