Healthcare Provider Details

I. General information

NPI: 1821317785
Provider Name (Legal Business Name): CARSON CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MILL ST 77 MILL ST
WESTFIELD MA
01085-4598
US

IV. Provider business mailing address

77 MILL ST
WESTFIELD MA
01085-4598
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SUREYYA ISCAN
Title or Position: CLINICIAN
Credential: PH.D.
Phone: 413-568-6141