Healthcare Provider Details

I. General information

NPI: 1538403969
Provider Name (Legal Business Name): STETSON SCHOOL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SOUTH STREET
BARRE MA
01005-0309
US

IV. Provider business mailing address

P.O. BOX 309 455 SOUTH STREET
BARRE MA
01005-0309
US

V. Phone/Fax

Practice location:
  • Phone: 978-355-4541
  • Fax: 978-355-6335
Mailing address:
  • Phone: 978-355-4151
  • Fax: 978-355-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1475995
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1475995
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number1475136
License Number StateMA

VIII. Authorized Official

Name: MR. JOSEPH ALLRED
Title or Position: VICE PRESIDENT
Credential: J.D., M.S.
Phone: 978-355-4541