Basic Information
| Provider Information | |||||||||
| NPI: | 1508217043 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARVARD STREET NEIGHBORHOOD HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 BLUE HILL AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021242902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178227143 | ||||||||
| FaxNumber: | 6172821450 | ||||||||
| Practice Location | |||||||||
| Address1: | 895 BLUE HILL AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021242902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178227143 | ||||||||
| FaxNumber: | 6172821450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ZIMMERMAN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7178225516 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 9 | MA | Y | Agencies | Community/Behavioral Health |
No ID Information.