Healthcare Provider Details

I. General information

NPI: 1821435488
Provider Name (Legal Business Name): THOM NEOPONSET VALLEY EARLY INTERVENTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 MAIN ST
NORFOLK MA
02056-1418
US

IV. Provider business mailing address

58 MAIN ST
NORFOLK MA
02056-1418
US

V. Phone/Fax

Practice location:
  • Phone: 508-954-6800
  • Fax:
Mailing address:
  • Phone: 508-954-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number7960
License Number StateMA

VIII. Authorized Official

Name: DONNA FROYDMA
Title or Position: DIRECTOR
Credential: MA, CEIS/D
Phone: 781-551-0405