MEDICARE: PERSEVERANCE BEHAVIORAL HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1588245948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSEVERANCE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	415 BOSTON TPKE STE 308A
Second Line	:
City	:	SHREWSBURY
State	:	MA
Zip	:	01545-3446
Country	:	US
Telephone Number	:	508-266-0999
Fax Number	:	774-374-8067

Provider Business Practice Location Address
First Line	:	45 LYMAN ST STE 25
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-2658
Country	:	US
Telephone Number	:	508-266-0999
Fax Number	:	774-374-8067

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	SHANISE PEREZ
Credential	:	PMHNP
Telephone Number	:	508-266-0999

Provider Enumeration Date	:	04/17/2021
Last Update Date	:	09/25/2023

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