Basic Information
| Provider Information | |||||||||
| NPI: | 1376078378 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHPRO PEDIATRICS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76 ACCORD PARK DR | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020611606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819230900 | ||||||||
| FaxNumber: | 7816163306 | ||||||||
| Practice Location | |||||||||
| Address1: | 695 S COLORADO BLVD | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802468008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819230900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2017 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | SCOTT | ||||||||
| AuthorizedOfficialFirstName: | TERRA | ||||||||
| AuthorizedOfficialMiddleName: | RAE | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP OUTPATIENT PEDIATRICS | ||||||||
| AuthorizedOfficialTelephone: | 3034374364 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.