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General NPI Number Information
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NPI Number | 1235221573
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Entity Type | Organization
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Legal Business Name | RIVERSIDE COUNSELING CENTER, INC.
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 85 CONSTITUTION LN SUITE 3C1
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City | DANVERS
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State | MA
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Zip | 01923-3694
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Country | US
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Telephone | 978-777-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 115 BRAY ST
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City | GLOUCESTER
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State | MA
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Zip | 01930-1553
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Country | US
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Telephone | 978-281-7545
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JAMIE K KESHET
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Credential | ED.D.
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Telephone | 978-777-1119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6093
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License Number State | MA
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