| Granite Pond, Llc | |
|
85 Exchange St Ste 202 Lynn MA 01901-1400 | |
| (617) 326-3014 | |
| (617) 326-3013 |
| Full Name | Granite Pond, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 85 Exchange St Ste 202, Lynn, Massachusetts |
| Authorized Official Name and Position | Christopher M Miller (SOLE PROPRIETOR) |
| Authorized Official Contact | 6173263014 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Granite Pond, Llc Po Box 471 Lynn MA 01903-0571 Ph: (617) 326-3014 | Granite Pond, Llc 85 Exchange St Ste 202 Lynn MA 01901-1400 Ph: (617) 326-3014 |
| NPI Number | 1396081196 |
|---|---|
| Provider Enumeration Date | 12/25/2012 |
| Last Update Date | 12/22/2025 |
| Certification Date | 12/22/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396081196 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 8106 (Massachusetts) | Primary |
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