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BEHAVIORAL NUTRITION

Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder)

Provider NPI: 1851686455

Organization Information:
Organization Name:  BEHAVIORAL NUTRITION
Organization is not Subpart
Authorized Official:  MICHELE  QUINLAN  CLINICAL SUPERVISOR  617-372-3733

Practice Location:
1266 FURNACE BROOK PKWY SUITE 404 QUINCY, MA 02169-4758 US
Tel: 617-595-7044  Fax: 888-434-5097

Business Mailing Address:
1266 FURNACE BROOK PKWY SUITE 404 QUINCY, MA 02169-4758 US
Tel: 617-595-7044  Fax: 888-434-5097

NPI Information:
NPI: 1851686455
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
MA5757
N101YP2500XBehavioral Health & Social Service Providers
Counselor
MA5757
N133V00000XDietary & Nutritional Service Providers
Dietitian, Registered
N133VN1004XDietary & Nutritional Service Providers
Dietitian, Registered
N133VN1006XDietary & Nutritional Service Providers
Dietitian, Registered
N103TP0016XBehavioral Health & Social Service Providers
Psychologist
MA75391
Y101YM0800XBehavioral Health & Social Service Providers
Counselor
MA5757

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 101YM0800X

Type:

Classification:



Definition:



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