Provider Demographics
NPI:1891112058
Name:MAY INSTITUTE
Entity Type:Organization
Organization Name:MAY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PHANEUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-468-4049
Mailing Address - Street 1:14 PACELLA PARK DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-1756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 PACELLA PARK DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-1756
Practice Address - Country:US
Practice Address - Phone:781-437-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265Medicaid