Healthcare Provider Details

I. General information

NPI: 1770541948
Provider Name (Legal Business Name): COMPREHENSIVE OUTPATIENT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COURTHOUSE LN SUITE 3
CHELMSFORD MA
01824-1715
US

IV. Provider business mailing address

2 COURTHOUSE LN SUITE 3
CHELMSFORD MA
01824-1715
US

V. Phone/Fax

Practice location:
  • Phone: 978-275-9444
  • Fax: 978-453-9394
Mailing address:
  • Phone: 978-275-9444
  • Fax: 978-453-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4196
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4196
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number4196
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4196
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4196
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number4196
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4196
License Number StateMA
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4196
License Number StateMA
# 9
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4196
License Number StateMA
# 10
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4196
License Number StateMA
# 11
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4196
License Number StateMA
# 12
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4196
License Number StateMA
# 13
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4196
License Number StateMA

VIII. Authorized Official

Name: DR. BRUCE LESLIE MERMELSTEIN
Title or Position: PRESIDENT
Credential: ED. D.,
Phone: 617-527-4610