Provider Demographics
NPI:1578674289
Name:SOMERVILLE MENTAL HEALTH ASSOCIATION, INC.
Entity Type:Organization
Organization Name:SOMERVILLE MENTAL HEALTH ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LENROW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-625-0710
Mailing Address - Street 1:167 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2401
Mailing Address - Country:US
Mailing Address - Phone:617-625-0710
Mailing Address - Fax:617-625-6339
Practice Address - Street 1:167 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2401
Practice Address - Country:US
Practice Address - Phone:617-625-0710
Practice Address - Fax:617-625-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1002850OtherNEIGHBORHOOD HEALTH PLAN
MA996249OtherNETWORK HEALTH
MA1302515Medicaid
MA053045860OtherDUNS
MA1309889Medicaid
MAM184480OtherBLUE CROSS OF MA
MA701166OtherTUFTS HEALTH PLAN
MA011301390OtherRTG
MA996249OtherNETWORK HEALTH
MA=========OtherFEIN
MA996249OtherNETWORK HEALTH