Provider Demographics
NPI:1568753457
Name:SOMERS, JUSTIN STEPHEN
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:STEPHEN
Last Name:SOMERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 N BROADWAY
Mailing Address - Street 2:APT 203
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 PORTLAND ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1721
Practice Address - Country:US
Practice Address - Phone:978-687-6300
Practice Address - Fax:978-682-4843
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)