Phoenix, Sage Imogene
Phoenix, Sage Imogene is an sole proprietor health care provider with primary practice located at 4238 Washington St, Ste 313 , Roslindale MA 02131. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Phoenix, Sage Imogene can be contacted via phone (617) 453-8512.Contact Information
Primary practice address
4238 Washington St, Ste 313
Roslindale MA 02131
Phone: (617) 453-8512
Fax: (617) 992-2580
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | 9606 | Massachusetts |
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X |
Profile Details
| NPI number | 1598001828 |
|---|---|
| LBN Legal business name | Phoenix, Sage Imogene |
| Credentials | LMHC (MA #9606) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 13th, 2012 |
| Last updated | Mar 6th, 2025 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1598001828 | NPPES |
| Massachusetts | MEDICAID | 110026265E |
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