Affect Provider Group P.S.C.

Organization Active NPI Mental Health Counselor · Boston, MA

NPI 1689554362 · NPPES record last updated Aug 20, 2026

Key facts

NPI
1689554362
Entity type
Organization (NPI type 2)
Primary specialty
Mental Health Counselor 101YM0800X
Legal business name
AFFECT PROVIDER GROUP P.S.C.
Practice address
90 Canal St Ste 4
Boston, MA 02114-2022
Phone
(845) 769-8758
NPI assigned
Sep 4, 2025
Organization subpart
No

Authorized official

Name
Karla Renee Mullings
Title
Director of Compliance
Phone
(845) 768-8758

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 22

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20260330000115 MA Part B Supplier - Clinic/Group Practice 5597105684 Receives reassigned benefits from 1 practitioner
Practice locations: Boston, MA

National Provider Directory

Tax ID family
Affect (23 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor
Group: 193200000X MULTI-SPECIALTY GROUP
101YM0800X Yes
Professional Counselor
Group: 193200000X MULTI-SPECIALTY GROUP
101YP2500X
Clinical Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP
1041C0700X
Marriage & Family Therapist
Group: 193200000X MULTI-SPECIALTY GROUP
106H00000X
Psychiatric/Mental Health Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP
363LP0808X

Addresses

Primary practice location

90 Canal St Ste 4
Boston, MA 02114-2022

Mailing address

PO Box 96635
Phoenix, AZ 85072-6635
Phone (845) 760-8758

Other providers in Boston, MA

All providers in Boston, MA · Mental Health Counselor in Massachusetts

Sources for this page

Verify at the official NPI Registry.