Organization
REUNITED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON GHOLSON LCSW (INTAKE COORDINATOR)
(857) 939-4445
Entity
Organization
Contact information
Practice address
1354 HANCOCK ST STE 205, QUINCY, MA 02169-5109
(857) 939-4445
Mailing address
1354 HANCOCK ST STE 205, QUINCY, MA 02169-5109
(857) 939-4445
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366796070
—
MA
Enumeration date
01/03/2023
Last updated
01/26/2023
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