Healthcare Provider Details

I. General information

NPI: 1215975842
Provider Name (Legal Business Name): THE CARSON CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BROAD ST
WESTFIELD MA
01085-2902
US

IV. Provider business mailing address

77 MILL ST SUITE 251
WESTFIELD MA
01085-4598
US

V. Phone/Fax

Practice location:
  • Phone: 413-568-1421
  • Fax: 413-572-4107
Mailing address:
  • Phone: 413-568-6141
  • Fax: 413-572-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number51117
License Number StateMA

VIII. Authorized Official

Name: AISIK NEWMAN
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 413-568-6141