Healthcare Provider Details

I. General information

NPI: 1326286873
Provider Name (Legal Business Name): REDIGER PSYCHIATRIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N PEARL ST
BROCKTON MA
02301-1794
US

IV. Provider business mailing address

235 N PEARL ST
BROCKTON MA
02301-1794
US

V. Phone/Fax

Practice location:
  • Phone: 508-588-4000
  • Fax:
Mailing address:
  • Phone: 508-588-4000
  • Fax: 508-894-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number170600
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number133760
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number159462
License Number StateMA

VIII. Authorized Official

Name: DR. JEFFREY D. REDIGER
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 774-419-1017