Healthcare Provider Details

I. General information

NPI: 1336473131
Provider Name (Legal Business Name): THE ACADEMY NORTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WOBURN ST SUITE #5
READING MA
01867-2973
US

IV. Provider business mailing address

36 WOBURN ST. SUITE #5
READING MA
01867-2903
US

V. Phone/Fax

Practice location:
  • Phone: 781-942-9277
  • Fax: 781-944-6535
Mailing address:
  • Phone: 781-942-9277
  • Fax: 781-944-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115254
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JEFFREY COLUCCI
Title or Position: CO-DIRECTOR
Credential: PH.D.
Phone: 781-942-9277