Organization
CITYPSYCH WELLNESS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN HERAVI RN (PRESIDENT)
(617) 797-1746
Entity
Organization
Contact information
Practice address
333 LEE BURBANK HWY STE 2, REVERE, MA 02151-4003
(617) 242-1000
(617) 242-1099
Mailing address
333 LEE BURBANK HWY STE 2, REVERE, MA 02151-4003
(617) 242-1000
(617) 242-1099
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110099933/B
MEDICAID
MA
Enumeration date
05/03/2017
Last updated
05/03/2017
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