Provider Demographics
NPI:1619181880
Name:NORTHEASTERN UNIVERSITY, UNIVERSITY HEALTH & COUNSELING SERVICES
Entity Type:Organization
Organization Name:NORTHEASTERN UNIVERSITY, UNIVERSITY HEALTH & COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-373-7523
Mailing Address - Street 1:1 ABERDEEN WAY
Mailing Address - Street 2:UNIT 206
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4626
Mailing Address - Country:US
Mailing Address - Phone:617-492-2619
Mailing Address - Fax:
Practice Address - Street 1:135 FORSYTH ST
Practice Address - Street 2:360 HUNTINGTON AVE.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5024
Practice Address - Country:US
Practice Address - Phone:617-373-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA254638261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health