Healthcare Provider Details

I. General information

NPI: 1245856335
Provider Name (Legal Business Name): MCAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHIEF JUSTICE CUSHING HWY
COHASSET MA
02025-1201
US

IV. Provider business mailing address

1 CHIEF JUSTICE CUSHING HWY
COHASSET MA
02025-1201
US

V. Phone/Fax

Practice location:
  • Phone: 954-993-2040
  • Fax: 954-990-6305
Mailing address:
  • Phone: 954-993-2040
  • Fax: 954-990-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHERITA CHANG
Title or Position: CHIEF REVENUE OFFICER
Credential: MS
Phone: 954-993-2040