Healthcare Provider Details

I. General information

NPI: 1952831224
Provider Name (Legal Business Name): CARING BRIDGES SOCIAL WORK & CASE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CHOATE ST
ESSEX MA
01929-1057
US

IV. Provider business mailing address

29 CHOATE ST
ESSEX MA
01929-1057
US

V. Phone/Fax

Practice location:
  • Phone: 978-491-8662
  • Fax:
Mailing address:
  • Phone: 978-491-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number117432
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JOELLEN MARIE FALK
Title or Position: AUTHORIZED OFFICIAL
Credential: LICSW
Phone: 978-491-8662