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NPI Code Detail

MEDICARE: DVA

MEDICARE: DVA
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
1283Q00000XPsychiatric Hospital002701CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1002701OTHERCTLCSW

General Provider Information

NPI Number : 1972538783
Entity Type Code : Organization
Provider Name (Legal Business Name) : DVA
Provider Business Mailing Address
First Line : 421 NORTH MAIN STREET
Second Line : VA MEDICAL CENTER
City : LEEDS
State : MA
Zip : 01053-9764
Country : US
Telephone Number : 413-582-3038
Fax Number :
Provider Business Practice Location Address
First Line : 421 N MAIN ST
Second Line : VA MEDICAL CENTER
City : LEEDS
State : MA
Zip : 01053-9764
Country : US
Telephone Number : 413-582-3038
Fax Number :
Authorized Official
Title or Position : CREDENTILING COORDINATOR
Name : MS. DENISE CAVANAUGH
Credential :
Telephone Number : 413-584-4040
Provider Enumeration Date : 07/11/2006
Last Update Date : 08/22/2020

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Directions to “DVA ” Practice Location

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