Healthcare Provider Details

I. General information

NPI: 1538435110
Provider Name (Legal Business Name): SAFE HARBOR COUNSELING OF THE NORTH SHORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 PLEASANT ST
GLOUCESTER MA
01930-5937
US

IV. Provider business mailing address

582 WESTERN AVE
GLOUCESTER MA
01930-5138
US

V. Phone/Fax

Practice location:
  • Phone: 978-381-9742
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1360
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMY MICHAELS
Title or Position: MANAGER
Credential: LMFT
Phone: 978-381-9742