Healthcare Provider Details

I. General information

NPI: 1396025938
Provider Name (Legal Business Name): SOUTHEAST COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 PLEASANT ST STE 101
BRIDGEWATER MA
02324-2473
US

IV. Provider business mailing address

1029 PLEASANT ST STE 101
BRIDGEWATER MA
02324-2473
US

V. Phone/Fax

Practice location:
  • Phone: 339-236-1309
  • Fax:
Mailing address:
  • Phone: 339-236-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number114158
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number114158
License Number StateMA

VIII. Authorized Official

Name: SUSAN MARGARET RAMONDETTA
Title or Position: SOLE MEMBER
Credential: LICSW
Phone: 508-697-1070