MYSTIC LEARNING CENTER, INC. (NPI# 1881806750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881806750 |
| Entity Type | Organization |
| Organization Name | MYSTIC LEARNING CENTER, INC. |
| Practice Address |
530 Mystic Avenue Room 103 Somerville MA 02145-1602 |
| Practice Telephone | 6176230110 |
| Practice Fax Number | 6176234750 |
| Mailing Telephone | 6176230110 |
| Mailing Fax Number | 6176234750 |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MISS FLORENCE ELIZABETH BERGMANN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6176230110 |
| Authorized Official Credential | BACHELOR OF ARTS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251V00000X | Voluntary or Charitable | 1221890 | MA | Agencies |
| Street Address |
530 MYSTIC AVENUE ROOM 103 |
| City | SOMERVILLE |
| State | MA |
| Zip Code | 02145-1602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497230684 | Marisa Katherine Glynn | Psychologist | 35 Edgar Avenue, Somerville, MA 02145 | 2018-10-03 |
| 1811478274 | Rolanda Santos Prophete | Counselor | 18 Sargent Ave, Somerville, MA 02145 | 2018-08-23 |
| 1619465101 | Shannon Comer | Registered Nurse | 64 Sycamore St Apartment 1, Somerville, MA 02145 | 2018-04-30 |
| 1184121261 | Deborah Camara | Social Worker | 89 Cross Street, Apt 1, Somerville, MA 02145 | 2018-04-06 |
| 1073047569 | Nicole Patzelt | Dermatology | 192a School St Apt 2, Somerville, MA 02145 | 2017-04-12 |
| 1316327018 | Christina Gasbarro | Family Medicine | Cha Assembly Square Care Center, 5 Middlesex Avenue, Somerville, MA 02145 | 2015-06-08 |
| 1902236359 | Prativa Bhatta | Counselor | 76 Cross St, Somerville, MA 02145 | 2013-11-21 |
| 1427497015 | Veronica Wu | Physician Assistant | 60 Clyde Street, #5, Somerville, MA 02145 | 2013-06-18 |
| 1790045797 | Cambridge Health Alliance | Rehabilitation Unit | 2 Middlesex Avenue, Somerville, MA 02145 | 2012-05-23 |
| 1871809665 | Lauren Holland | Occupational Therapist | 5 Middlesex Avenue, Somerville, MA 02145 | 2010-08-31 |
| Find all providers in zip 02145 | ||||
| Taxonomy Code | 251V00000X |
| Grouping | Agencies |
| Classification | Voluntary or Charitable |
| Definition to come... |
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| 1073848370 | The Arc of Greater Haverhill-newburyport | Voluntary or Charitable | 57 Wingate St Ste 301, Haverhill, MA 01832-5759 | 2009-10-05 |
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| Find all providers with the same taxonomy | ||||
| City | SOMERVILLE |
| Zip Code | 02145 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.