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General NPI Number Information
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NPI Number | 1336473131
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Entity Type | Organization
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Legal Business Name | THE ACADEMY NORTH, INC.
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 36 WOBURN ST SUITE #5
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City | READING
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State | MA
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Zip | 01867-2973
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Country | US
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Telephone | 781-942-9277
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Fax | 781-944-6535
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Provider Business Mailing Address
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Address Line | 36 WOBURN ST. SUITE #5
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City | READING
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State | MA
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Zip | 01867-2903
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Country | US
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Telephone | 781-942-9277
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Fax | 781-944-6535
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | DR. JEFFREY COLUCCI
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Credential | PH.D.
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Telephone | 781-942-9277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 115254
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License Number State | MA
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