Middlesex Human Service Agency, Inc.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

0280 Issued in MA

Legal business name

MIDDLESEX HUMAN SERVICE AGENCY, INC.

Practice address

65 Glen Rd
Boston, MA 02130-3340

Phone

(617) 524-4416

Fax

(617) 524-4450

NPI assigned

Jan 22, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Mills, LADC I, NCAC II, SAP

Title

Chief Executive Officer

Phone

(781) 894-6110

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632096000000",
    "number": "1700394962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 PROSPECT ST STE 3",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024538509",
            "telephone_number": "781-894-6110",
            "fax_number": "781-647-0412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 GLEN RD",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021303340",
            "telephone_number": "617-524-4416",
            "fax_number": "617-524-4450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12 Lowell St",
            "address_purpose": "LOCATION",
            "city": "Waltham",
            "state": "MA",
            "postal_code": "024535254",
            "country_code": "US",
            "telephone_number": "781-899-2540",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 G St",
            "address_purpose": "LOCATION",
            "city": "South Boston",
            "state": "MA",
            "postal_code": "021271408",
            "country_code": "US",
            "telephone_number": "617-268-7124",
            "fax_number": "617-268-5572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIDDLESEX HUMAN SERVICE AGENCY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-22",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "781-894-6110",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LADC I, NCAC II, SAP"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MA",
            "license": "0280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Micro Endodontics LLC
• Microsurgical Endodontics
• Betsy C Micucci, M.S., CCC/SLP
• Lynn Midani, MD
• Roeland J. Middelbeek, M.D.
• Jordan Middleton
• Justin Alexander Middleton, DMD
• Meghan Sullivan Middleton, PNP, CNS
• Ravyn Yoko Middleton, MD
• Nan Sara Midgley, RN

• Substance Abuse Rehabilitation Facility in Boston, MA
• Providers in Boston, MA by specialty
• Substance Abuse Rehabilitation Facility in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.