Provider Demographics
NPI:1417520370
Name:A NEW LENS CONSULTANT & LIFE COACHING SERVICES
Entity Type:Organization
Organization Name:A NEW LENS CONSULTANT & LIFE COACHING SERVICES
Other - Org Name:A NEW LENS CONSULTANT & LIFE COACHING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEVRY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW AND LIFE COACH
Authorized Official - Phone:781-866-3191
Mailing Address - Street 1:4 EXCHANGE AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6309
Mailing Address - Country:US
Mailing Address - Phone:781-763-7724
Mailing Address - Fax:
Practice Address - Street 1:4 EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6309
Practice Address - Country:US
Practice Address - Phone:781-866-3191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1588161707Medicaid