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General NPI Number Information
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NPI Number | 1376928937
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Entity Type | Organization
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Legal Business Name | MSPCC MASS SOCIETY OF PREVENTION OF CRUALTY TO CHILDREN
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 9 SULLIVAN RD
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City | HOLYOKE
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State | MA
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Zip | 01040-2841
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Country | US
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Telephone | 413-532-9446
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Fax | 413-532-0447
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Provider Business Mailing Address
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Address Line | 9 SULLIVAN RD
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City | HOLYOKE
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State | MA
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Zip | 01040-2841
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Country | US
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Telephone | 413-532-9446
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Fax | 413-532-0447
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Authorized Official
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Title or Position | CLINIC SUPERVISOR
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Name | DR. BERNARD M MARSHALL
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Credential | PH.D.
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Telephone | 413-532-9446
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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 | 1285712596
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License Number State | MA
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