Healthcare Provider Details

I. General information

NPI: 1568120343
Provider Name (Legal Business Name): BRIGHT ACT BEHAVIORAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GROVE ST STE 217C
WORCESTER MA
01605-2647
US

IV. Provider business mailing address

36 PIONEER LN
AUBURN MA
01501-1848
US

V. Phone/Fax

Practice location:
  • Phone: 774-431-0272
  • Fax: 949-862-8636
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY N WAITHANJI
Title or Position: OWNER: MANAGING DIRECTOR
Credential:
Phone: 508-524-0323