Provider Demographics
NPI:1740543495
Name:HARBOR HOUSE
Entity type:Organization
Organization Name:HARBOR HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUSATERI
Authorized Official - Suffix:
Authorized Official - Credentials:MS , CCC
Authorized Official - Phone:781-264-2920
Mailing Address - Street 1:10 MOON ST
Mailing Address - Street 2:#2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113-2002
Mailing Address - Country:US
Mailing Address - Phone:781-264-2920
Mailing Address - Fax:
Practice Address - Street 1:10 MOON ST
Practice Address - Street 2:APT. #2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113-2002
Practice Address - Country:US
Practice Address - Phone:781-264-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7278310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility