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1705 Columbus Ave. Roxbury MA 02119 | |
| (617) 516-5150 | |
| (617) 442-6915 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1705 Columbus Ave., Roxbury, Massachusetts |
| Authorized Official Name and Position | Bruce L Bird (CEO) |
| Authorized Official Contact | 6174411770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1705 Columbus Ave Roxbury MA 02119 Ph: (617) 516-5150 | 1705 Columbus Ave. Roxbury MA 02119 Ph: (617) 516-5150 |
| NPI Number | 1659302396 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 02/09/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659302396 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 4211 (Massachusetts) | Primary |
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