Provider Demographics
NPI:1144497124
Name:GENERATION EXCEL YOUTH PROGRAM
Entity type:Organization
Organization Name:GENERATION EXCEL YOUTH PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NESBETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-524-7900
Mailing Address - Street 1:215 FOREST HILLS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3302
Mailing Address - Country:US
Mailing Address - Phone:617-524-7900
Mailing Address - Fax:617-524-4169
Practice Address - Street 1:215 FOREST HILLS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3302
Practice Address - Country:US
Practice Address - Phone:617-524-7900
Practice Address - Fax:617-524-4169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty