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General NPI Number Information
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NPI Number | 1396025938
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Entity Type | Organization
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Legal Business Name | SOUTHEAST COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 1029 PLEASANT ST STE 101
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City | BRIDGEWATER
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State | MA
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Zip | 02324-2473
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Country | US
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Telephone | 339-236-1309
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 PLEASANT ST STE 101
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City | BRIDGEWATER
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State | MA
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Zip | 02324-2473
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Country | US
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Telephone | 339-236-1309
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | SUSAN MARGARET RAMONDETTA
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Credential | LICSW
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Telephone | 508-697-1070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 114158
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 114158
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License Number State | MA
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