Basic Information
| Provider Information | |||||||||
| NPI: | 1649399460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARVARD VANGUARD MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 GROVE ST | ||||||||
| Address2: | SUITE 3-300 | ||||||||
| City: | AUBURNDALE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024662272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598096 | ||||||||
| FaxNumber: | 6174213487 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 WORCESTER ST | ||||||||
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| City: | WELLESLEY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024815420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814315270 | ||||||||
| FaxNumber: | 7814315535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GEIHSLER | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6175598012 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | 104100000X | X | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 364S00000X | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
ID Information
| ID | Type | State | Issuer | Description | 669500 | 01 | MA | TUFTS | OTHER |