Healthcare Provider Details

I. General information

NPI: 1215447297
Provider Name (Legal Business Name): TREATMENT PARTNERS OF MASSACHUSETTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 MAIN ST UNIT 7R
HYANNIS MA
02601-4366
US

IV. Provider business mailing address

83 WEST WAY
MASHPEE MA
02649-3536
US

V. Phone/Fax

Practice location:
  • Phone: 617-598-2998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATHEW GORMAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 512-858-9600