Healthcare Provider Details

I. General information

NPI: 1447496237
Provider Name (Legal Business Name): PROSPECT HILL CONSULTANTS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2008
Last Update Date: 12/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WATERHOUSE RD
BOURNE MA
02532-3897
US

IV. Provider business mailing address

1 DOGWOOD RD
BOURNE MA
02532-2227
US

V. Phone/Fax

Practice location:
  • Phone: 508-759-7279
  • Fax: 508-888-7553
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1022699
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number160572
License Number StateMA

VIII. Authorized Official

Name: MR. JOHN MOORE
Title or Position: VICE PRESIDENT
Credential:
Phone: 508-759-7279