Provider Demographics
NPI:1497518609
Name:EVA RAY SENNER, LLC
Entity Type:Organization
Organization Name:EVA RAY SENNER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SENNER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-505-5212
Mailing Address - Street 1:47 HIGH ST # 6
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3808
Mailing Address - Country:US
Mailing Address - Phone:781-960-8218
Mailing Address - Fax:617-326-3021
Practice Address - Street 1:707 FULTON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1013
Practice Address - Country:US
Practice Address - Phone:781-960-8218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health