Provider Demographics
NPI:1871818203
Name:PRIORITY PROFESSIONAL CARE
Entity Type:Organization
Organization Name:PRIORITY PROFESSIONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YANICK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:978-496-0107
Mailing Address - Street 1:1613 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2123
Mailing Address - Country:US
Mailing Address - Phone:857-598-4774
Mailing Address - Fax:
Practice Address - Street 1:1613 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2123
Practice Address - Country:US
Practice Address - Phone:857-598-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health