Healthcare Provider Details

I. General information

NPI: 1083924013
Provider Name (Legal Business Name): NEW ENGLAND CENTER FOR PSYCHIATRIC AND ADDICTION DISORDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PARK ST
ATTLEBORO MA
02703-2338
US

IV. Provider business mailing address

24 PARK ST
ATTLEBORO MA
02703-2338
US

V. Phone/Fax

Practice location:
  • Phone: 508-222-0089
  • Fax: 508-222-0095
Mailing address:
  • Phone: 508-222-0089
  • Fax: 508-222-0095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71995
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number71995
License Number StateMA

VIII. Authorized Official

Name: ILEANA BERMAN
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: MD
Phone: 508-222-0089