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General NPI Number Information
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NPI Number | 1417023672
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Entity Type | Organization
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Legal Business Name | WILLIAMSTOWN BEHAVIORAL HEALTH ASSOCIATES
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 77 HOSPITAL AVE STE 214
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City | NORTH ADAMS
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State | MA
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Zip | 01247-2538
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Country | US
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Telephone | 413-398-5064
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Fax | 413-398-5496
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Provider Business Mailing Address
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Address Line | 681 SIMONDS RD
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City | WILLIAMSTOWN
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State | MA
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Zip | 01267
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Country | US
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Telephone | 413-458-9600
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Fax | 413-458-4028
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | JEREMY RAY SULLIVAN
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Credential | PSYD
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Telephone | 413-398-5064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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