Healthcare Provider Details

I. General information

NPI: 1891771267
Provider Name (Legal Business Name): SOUTHEASTERN PSYCHIATRIC ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 N MAIN ST
RANDOLPH MA
02368
US

IV. Provider business mailing address

1093 N MAIN ST
RANDOLPH MA
02368
US

V. Phone/Fax

Practice location:
  • Phone: 781-963-7775
  • Fax: 781-963-7776
Mailing address:
  • Phone: 781-963-7775
  • Fax: 781-963-7776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: MR. DEAN SOLOMON
Title or Position: PRESIDENT
Credential: MD
Phone: 781-963-7775