=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124700448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BE. BEHAVIORAL HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2023
-----------------------------------------------------
Last Update Date | 08/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 HEALY ST
-----------------------------------------------------
City | WEST SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01089-3120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-328-5355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1129 RIVERDALE ST # 1009
-----------------------------------------------------
City | WEST SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01089-4615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-264-2620
-----------------------------------------------------
Fax | 413-264-2690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JULIA ANN BERBERENA
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 413-328-5355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------