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General NPI Number Information
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NPI Number | 1114107034
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Entity Type | Organization
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Legal Business Name | SEVENHILLS CLINICAL ASSOCIATES
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 22 GRANT RD
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City | DEVENS
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State | MA
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Zip | 01434-4468
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Country | US
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Telephone | 978-772-7170
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Fax | 978-772-7188
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Provider Business Mailing Address
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Address Line | 22 GRANT RD
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City | DEVENS
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State | MA
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Zip | 01434-4468
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Country | US
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Telephone | 978-772-7170
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Fax | 978-772-7188
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Authorized Official
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Title or Position | ASST. VP
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Name | MS. VALERIE VERONICA CHASE
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Credential | M.ED. CCC
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Telephone | 978-772-7170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 206970
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License Number State | MA
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