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General NPI Number Information
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NPI Number | 1346667466
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Entity Type | Organization
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Legal Business Name | AMY R OFFENBERG LLC
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 16 COHASSET ST FIRST FLOOR
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City | ROSLINDALE
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State | MA
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Zip | 02131-3013
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Country | US
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Telephone | 617-323-2825
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Fax |
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Provider Business Mailing Address
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Address Line | 16 COHASSET STREET FIRST FLOOR
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City | ROSLINDALE
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State | MA
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Zip | 02131
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Country | US
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Telephone | 617-323-2825
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMY R OFFENBERG
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Credential | MSW MPH LICSW
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Telephone | 617-323-2825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 118020
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License Number State | MA
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