Provider Demographics
NPI:1992233563
Name:MILLS, LEMUEL VASSAR JR (MSW)
Entity type:Individual
Prefix:MR
First Name:LEMUEL
Middle Name:VASSAR
Last Name:MILLS
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
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Mailing Address - Street 1:35 BRADLEE ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3205
Mailing Address - Country:US
Mailing Address - Phone:617-792-4906
Mailing Address - Fax:617-541-9901
Practice Address - Street 1:321 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02121-4302
Practice Address - Country:US
Practice Address - Phone:617-541-6859
Practice Address - Fax:617-445-2125
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA467450101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS35214203OtherDRIVERS LICENSE