Healthcare Provider Details

I. General information

NPI: 1174947014
Provider Name (Legal Business Name): CROSSWALK BEHAVIORAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 MAIN ST SUITE 2C
WESTMINSTER MA
01473-1472
US

IV. Provider business mailing address

PO BOX 245
WESTMINSTER MA
01473-0245
US

V. Phone/Fax

Practice location:
  • Phone: 978-668-5099
  • Fax: 978-668-5092
Mailing address:
  • Phone: 978-668-5099
  • Fax: 978-668-5092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8473
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4847
License Number StateMA

VIII. Authorized Official

Name: MS. LINDA G CHARPENTIER
Title or Position: FOUNDER/CEO
Credential: MA, LMHC
Phone: 978-668-5099