NPIMap

Organization Active NPI

Mystic Learning Center, Inc.

  • Voluntary or Charitable Agency
  • Somerville, MA
National Provider Identifier
1881806750
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Voluntary or Charitable AgencyTaxonomy code 251V00000X
License
1221890 Issued in MA
Legal business name
MYSTIC LEARNING CENTER, INC.
Practice address
530 Mystic Avenue Room 103
Somerville, MA 02145-1602
Phone
(617) 623-0110
Fax
(617) 623-4750
NPI assigned
May 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Miss Florence Elizabeth Bergmann, BACHELOR OF ARTS
Title
Executive Director
Phone
(617) 623-0110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Voluntary or Charitable Agency 251V00000X 1221890 MA Primary

Addresses

Primary practice location

530 Mystic Avenue Room 103
Somerville, MA 02145-1602

Mailing address

530 Mystic Avenue Room 103
Somerville, MA 02145-1602
Phone (617) 623-0110

National Provider Directory

National Provider Directory

Locations

530 Mystic Ave
Ste 103
Somerville, MA 02145
Phone (617) 623-0110

NPI Registry JSON

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881806750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 MYSTIC AVENUE ROOM 103",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021451602",
            "telephone_number": "617-623-0110",
            "fax_number": "617-623-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 MYSTIC AVENUE ROOM 103",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021451602",
            "telephone_number": "617-623-0110",
            "fax_number": "617-623-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC LEARNING CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERGMANN",
        "authorized_official_first_name": "FLORENCE",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "617-623-0110",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "BACHELOR OF ARTS"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "MA",
            "license": "1221890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.