Healthcare Provider Details

I. General information

NPI: 1497339634
Provider Name (Legal Business Name): UBHS - UNLIMITED BEHAVIORAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 QUINCY AVE
BROCKTON MA
02302-2864
US

IV. Provider business mailing address

225 QUINCY AVE
BROCKTON MA
02302-2864
US

V. Phone/Fax

Practice location:
  • Phone: 888-763-7272
  • Fax: 877-243-2959
Mailing address:
  • Phone: 888-763-7272
  • Fax: 877-243-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EDWINNA WYNN
Title or Position: CEO
Credential:
Phone: 888-763-7272