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General NPI Number Information
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NPI Number | 1215455829
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Entity Type | Organization
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Legal Business Name | NEW BEGINNINGS OF SOUTHBRIDGE
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Dates
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Enumeration Date | 09/03/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 146 ASHLAND AVE SUITE B
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550
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Country | US
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Telephone | 774-318-1806
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Fax |
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Provider Business Mailing Address
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Address Line | 146 ASHLAND AVE SUITE B
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550
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Country | US
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Telephone | 774-318-1806
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Fax |
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Authorized Official
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Title or Position | FSS CLINICIAN
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Name | DR. SAMUEL W YOUNG
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Credential | DMIN
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Telephone | 774-318-1806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1186
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License Number State | MA
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