Healthcare Provider Details

I. General information

NPI: 1700385192
Provider Name (Legal Business Name): SERVICENET INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 BEACON ST
GREENFIELD MA
01301-2004
US

IV. Provider business mailing address

129 KING ST
NORTHAMPTON MA
01060-3258
US

V. Phone/Fax

Practice location:
  • Phone: 413-772-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0216
License Number StateMA

VIII. Authorized Official

Name: JAMES BRUCE FRUTKIN
Title or Position: VICE PRESIDENT OF CLINICAL SERVICES
Credential:
Phone: 413-582-9507