Healthcare Provider Details

I. General information

NPI: 1609116110
Provider Name (Legal Business Name): COMMUNITY BASED SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 GREENWOOD AVE ATT: LOUIS SIMONS
SWAMPSCOTT MA
01907-2145
US

IV. Provider business mailing address

84 GREENWOOD AVE ATT: LOUIS SIMONS
SWAMPSCOTT MA
01907-2145
US

V. Phone/Fax

Practice location:
  • Phone: 781-856-4341
  • Fax:
Mailing address:
  • Phone: 781-856-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. LOUIS SIMONS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 781-856-4341