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General NPI Number Information
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NPI Number | 1326286873
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Entity Type | Organization
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Legal Business Name | REDIGER PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 235 N PEARL ST
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City | BROCKTON
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State | MA
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Zip | 02301-1794
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Country | US
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Telephone | 508-588-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 235 N PEARL ST
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City | BROCKTON
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State | MA
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Zip | 02301-1794
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Country | US
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Telephone | 508-588-4000
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Fax | 508-894-8334
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. JEFFREY D. REDIGER
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Credential | M.D.
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Telephone | 774-419-1017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 170600
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 133760
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 159462
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License Number State | MA
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