Healthcare Provider Details

I. General information

NPI: 1144219551
Provider Name (Legal Business Name): FAMILY SERVICE ASSOCIATION OF GREATER FALL RIVER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 ROCK ST
FALL RIVER MA
02720-3201
US

IV. Provider business mailing address

PO BOX 70
FALL RIVER MA
02722-0070
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-7542
  • Fax: 508-676-3699
Mailing address:
  • Phone: 508-678-7542
  • Fax: 508-676-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberNONE
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4263
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4263
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4263
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4263
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4263
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number4263
License Number StateMA
# 8
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number4263
License Number StateMA
# 9
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4263
License Number StateMA

VIII. Authorized Official

Name: MS. CAROL A. NAGLE
Title or Position: CEO
Credential:
Phone: 508-730-1138