Provider Demographics
NPI:1235939927
Name:BLUE CIRCLE HEALTH CLINICAL INC
Entity type:Organization
Organization Name:BLUE CIRCLE HEALTH CLINICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LUCESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-213-2918
Mailing Address - Street 1:68 HARRISON AVE STE 605 PMB 62564
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1929
Mailing Address - Country:US
Mailing Address - Phone:888-404-4813
Mailing Address - Fax:888-675-4061
Practice Address - Street 1:68 HARRISON AVE STE 605
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1929
Practice Address - Country:US
Practice Address - Phone:888-404-4813
Practice Address - Fax:888-675-4061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE CIRCLE HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty