# MASSACHUSETTS CENTER FOR ADOLESCENT WELLNESS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164129177
- **Authorized official:** ED THATCHER (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (754) 217-8127

## Contact information

- **Practice address:** 230 BROADWAY STE 201, LYNNFIELD, MA 01940-2320
- **Practice address phone:** (781) 334-8781
- **Mailing address:** 230 BROADWAY STE 201, LYNNFIELD, MA 01940-2320

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |
| 261QR0405X | Substance Use Disorder Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/09/2023
- **Last updated:** 05/28/2024