Healthcare Provider Details

I. General information

NPI: 1518479039
Provider Name (Legal Business Name): RIGHT ROAD RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAIN ST
NORTHBOROUGH MA
01532-2132
US

IV. Provider business mailing address

17 MERLIN CT
WORCESTER MA
01602-1363
US

V. Phone/Fax

Practice location:
  • Phone: 508-579-0000
  • Fax:
Mailing address:
  • Phone: 508-579-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. TRACI SWEET
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 508-579-0000