Healthcare Provider Details

I. General information

NPI: 1760041685
Provider Name (Legal Business Name): CENTRAL MASS BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PARK AVE STE 500
WORCESTER MA
01609-1989
US

IV. Provider business mailing address

255 PARK AVE STE 500
WORCESTER MA
01609-1989
US

V. Phone/Fax

Practice location:
  • Phone: 413-886-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MERCEDES FERNANDEZ
Title or Position: ADMINITRATOR
Credential:
Phone: 413-886-2121