Provider Demographics
NPI:1588216378
Name:COMMONWEALTH MENTAL HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:COMMONWEALTH MENTAL HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-506-8188
Mailing Address - Street 1:895 BLUE HILL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2902
Mailing Address - Country:US
Mailing Address - Phone:617-506-8188
Mailing Address - Fax:617-506-5039
Practice Address - Street 1:895 BLUE HILL AVE STE 1
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2902
Practice Address - Country:US
Practice Address - Phone:617-506-8188
Practice Address - Fax:617-506-5039
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH MENTAL HEALTH & WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health