Healthcare Provider Details

I. General information

NPI: 1568770543
Provider Name (Legal Business Name): CLINICAL AND SUPPORT OPTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAIN ST 3RD FLOOOR
FLORENCE MA
01062-3160
US

IV. Provider business mailing address

10 MAIN ST 3RD FLOOOR
FLORENCE MA
01062-3160
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-8550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHAD MELVIN O'BRIEN
Title or Position: THERAPIST
Credential: M.S.W.
Phone: 413-582-0471