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General NPI Number Information
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NPI Number | 1215511332
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Entity Type | Organization
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Legal Business Name | BLACKBIRD COUNSELING
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 28 RIVERSIDE DR STE 270
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City | PEMBROKE
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State | MA
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Zip | 02359-4947
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Country | US
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Telephone | 774-773-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 28 RIVERSIDE DR STE 270
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City | PEMBROKE
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State | MA
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Zip | 02359-4947
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Country | US
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Telephone | 774-773-6300
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | JUSTINE CARLUCCI
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Credential | LMFT
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Telephone | 339-235-5116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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