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General NPI Number Information
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NPI Number | 1689720302
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Entity Type | Organization
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Legal Business Name | WESTSIDE BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 7 CHRISTY DRIVE SUITE 3
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 508-580-4611
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Fax | 508-580-4404
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Provider Business Mailing Address
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Address Line | 7 CHRISTY DRIVE SUITE 3
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City | BROCKTON
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State | MA
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Zip | 02301
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Country | US
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Telephone | 508-580-4611
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Fax | 508-580-4404
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Authorized Official
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Title or Position | PARTENER
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Name | MICHAEL STEPHEN WEINER
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Credential | LICSW
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Telephone | 508-580-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 7330
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License Number State | MA
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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 | 8177
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 104590
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 110746
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1027200
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License Number State | MA
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Taxonomy #6
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 94523
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License Number State | MA
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Taxonomy #7
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 90943
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License Number State | MA
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35081
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License Number State | MA
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Taxonomy #9
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 135140
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License Number State | MA
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Taxonomy #10
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 105028
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License Number State | MA
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