NORTH CHARLES MENTAL HEALTH RESEARCH & TRAINING FOUNDATION, INC

Provider Demographics

• NPI: 1356411862
• Name: NORTH CHARLES MENTAL HEALTH RESEARCH & TRAINING FOUNDATION, INC
• Entity type: Organization
• Organization Name: NORTH CHARLES MENTAL HEALTH RESEARCH & TRAINING FOUNDATION, INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CEO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: GARY
• Authorized Official - Middle Name: R
• Authorized Official - Last Name: HOULE
• Authorized Official - Phone: 617-864-0941
• Mailing Address - Street 1: 54 WASHBURN AVE
• Mailing Address - City: CAMBRIDGE
• Mailing Address - State: MA
• Mailing Address - Zip Code: 02140-1128
• Mailing Address - Country: US
• Mailing Address - Phone: 617-864-0941
• Mailing Address - Fax: 617-876-9760
• Practice Address - Street 1: 54 WASHBURN AVE
• Practice Address - City: CAMBRIDGE
• Practice Address - State: MA
• Practice Address - Zip Code: 02140-1128
• Practice Address - Country: US
• Practice Address - Phone: 617-864-0941
• Practice Address - Fax: 617-876-9760
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-11-09
• Last Update Date: 2020-01-24

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	103TC1900X	Behavioral Health & Social Service Providers	Psychologist	Counseling	Group - Multi-Specialty
No	104100000X	Behavioral Health & Social Service Providers	Social Worker		Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	2084A0401X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Addiction Medicine	Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	101Y00000X	Behavioral Health & Social Service Providers	Counselor		Group - Multi-Specialty
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	103TA0400X	Behavioral Health & Social Service Providers	Psychologist	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	2084P0802X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Addiction Psychiatry	Group - Multi-Specialty
No	251S00000X	Agencies	Community/Behavioral Health		Group - Multi-Specialty
No	261QM0850X	Ambulatory Health Care Facilities	Clinic/Center	Adult Mental Health	Group - Multi-Specialty
No	261QR0405X	Ambulatory Health Care Facilities	Clinic/Center	Rehabilitation, Substance Use Disorder

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MA	37052	Other	BOSTON HEALTHNET
MA	NHC222300091 40	Other	BLUE CROSS BLUE SHIELD
MA	119333300	Other	DEPT LABOR OWCP
MA	NHC222300091 41	Other	BLUE CROSS BLUE SHIELD
MA	NHC222300091 42	Other	BLUE CROSS BLUE SHIELD
MA	1303902	Medicaid
MA	99420501	Medicaid
MA	1005250	Medicaid
MA	1303929	Medicaid
MA	222301740	Other	BLUE CROSS BLUE SHIELD
MA	1306405	Medicaid
MA	1303902	Medicaid
MA	Y10115	Medicare ID - Type Unspecified	MENTAL HEALTH CLINIC
MA	1303902	Medicaid