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General NPI Number Information
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NPI Number | 1699269894
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Entity Type | Organization
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Legal Business Name | FORSYTHIA BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 131 COOLIDGE AVE APT 521
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City | WATERTOWN
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State | MA
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Zip | 02472-2800
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Country | US
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Telephone | 401-400-0636
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Fax |
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Provider Business Mailing Address
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Address Line | 131 COOLIDGE AVE APT 521
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City | WATERTOWN
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State | MA
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Zip | 02472-2800
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Country | US
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Telephone | 401-400-0636
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | SIMON DESJARDINS
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Credential | MD
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Telephone | 401-424-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD16019
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License Number State | RI
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