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607 North Ave Ofc 18 Wakefield MA 01880-1306 | |
| (781) 705-0567 | |
| (623) 666-6792 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 607 North Ave Ofc 18, Wakefield, Massachusetts |
| Authorized Official Name and Position | Jessica Moniz Goulart (OWNER) |
| Authorized Official Contact | 7817050567 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
607 North Ave Ofc 18 Wakefield MA 01880-1306 Ph: (781) 705-0567 | 607 North Ave Ofc 18 Wakefield MA 01880-1306 Ph: (781) 705-0567 |
| NPI Number | 1235723321 |
|---|---|
| Provider Enumeration Date | 03/01/2021 |
| Last Update Date | 12/18/2024 |
| Certification Date | 12/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235723321 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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