Provider Demographics
NPI:1750453536
Name:MENTAL HEALTH AFFILIATES
Entity Type:Organization
Organization Name:MENTAL HEALTH AFFILIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-872-1650
Mailing Address - Street 1:1290 WORCESTER RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5254
Mailing Address - Country:US
Mailing Address - Phone:508-872-1650
Mailing Address - Fax:508-370-7282
Practice Address - Street 1:1290 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5254
Practice Address - Country:US
Practice Address - Phone:508-872-1650
Practice Address - Fax:508-370-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013970OtherBEACON HEALTH STRATEGIES
665741OtherTUFTS HEALTH PLAN
MAP10389OtherBLUE CROSS BLUE SHIELD