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General NPI Number Information
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NPI Number | 1366861833
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Entity Type | Organization
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Legal Business Name | GREATER ESSEX THERAPY
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 161 S MAIN ST STE 207
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City | MIDDLETON
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State | MA
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Zip | 01949-2478
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Country | US
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Telephone | 603-320-6738
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Fax |
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Provider Business Mailing Address
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Address Line | 161 S MAIN ST STE 207
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City | MIDDLETON
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State | MA
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Zip | 01949-2478
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MR. THOMAS ANTHONY D'ALESSANDRO JR.
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Credential | LICSW
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Telephone | 603-320-6738
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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 | 116727
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7081
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License Number State | MA
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