MEDICARE: SALEM STREET HEALTHCARE INC

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	230249	MA

General Provider Information

NPI Number	:	1841427101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALEM STREET HEALTHCARE INC

Provider Business Mailing Address
First Line	:	285 SALEM ST
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01854-3517
Country	:	US
Telephone Number	:	978-452-9229
Fax Number	:	978-452-3752

Provider Business Practice Location Address
First Line	:	285 SALEM ST
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01854-3517
Country	:	US
Telephone Number	:	978-452-9229
Fax Number	:	978-452-3752

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	FIDA HASSAN
Credential	:	OWNER
Telephone Number	:	978-452-9229

Provider Enumeration Date	:	06/15/2009
Last Update Date	:	06/15/2009

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Directions to “SALEM STREET HEALTHCARE INC ” Practice Location

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