Healthcare Provider Details

I. General information

NPI: 1346397437
Provider Name (Legal Business Name): BEHAVIORAL HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SHREWSBURY ST
WORCESTER MA
01604-1689
US

IV. Provider business mailing address

435 SHREWSBURY ST
WORCESTER MA
01604-1689
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-5554
  • Fax: 508-752-0245
Mailing address:
  • Phone: 508-753-5554
  • Fax: 508-752-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number59555
License Number StateMA

VIII. Authorized Official

Name: AMJAD BAHNASSI
Title or Position: DIRECTOR
Credential: MD
Phone: 508-753-5554