Basic Information
| Provider Information | |||||||||
| NPI: | 1942778923 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAYFTEE: SUPPORTING ALTERNATIVE YOUTH & FAMILIES THROUGH EDUCATION &EM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3464 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | JAMAICA PLAIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021302665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178586362 | ||||||||
| FaxNumber: | 6175531945 | ||||||||
| Practice Location | |||||||||
| Address1: | 3464 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | JAMAICA PLAIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021302665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178586362 | ||||||||
| FaxNumber: | 6175531945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2018 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| AuthorizedOfficialLastName: | NISHMAN | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | MACNISH | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6178586362 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 7118 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.