Healthcare Provider Details

I. General information

NPI: 1073017331
Provider Name (Legal Business Name): WESTERN NEW ENGLAND INTEGRATED LEARNING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MAIN ST
FLORENCE MA
01062-3102
US

IV. Provider business mailing address

104 PETTICOAT HILL RD
WILLIAMSBURG MA
01096-9432
US

V. Phone/Fax

Practice location:
  • Phone: 413-329-3346
  • Fax:
Mailing address:
  • Phone: 413-329-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1025720
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DUNCAN LAIRD
Title or Position: CLINICAL DIRECTOR
Credential: LICSW
Phone: 413-329-3346