Healthcare Provider Details

I. General information

NPI: 1912298027
Provider Name (Legal Business Name): FAMILY PSYCHIATRIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR SUITE 541-G
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

100 CUMMINGS CTR SUITE 541-G
BEVERLY MA
01915-6115
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-4900
  • Fax: 978-922-4955
Mailing address:
  • Phone: 978-922-4900
  • Fax: 978-922-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number223765
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113055
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MICHAEL TSAPPIS
Title or Position: AGENT
Credential: M.D.
Phone: 978-922-4900