Healthcare Provider Details

I. General information

NPI: 1033712179
Provider Name (Legal Business Name): MIDDLESEX RECOVERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 STILES RD STE 206
SALEM NH
03079-2851
US

IV. Provider business mailing address

20 TOWER OFFICE PARK
WOBURN MA
01801-2113
US

V. Phone/Fax

Practice location:
  • Phone: 603-824-6937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRUCE JARVIE
Title or Position: VP, TREASURER
Credential:
Phone: 214-379-3300