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General NPI Number Information
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NPI Number | 1700385192
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Entity Type | Organization
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Legal Business Name | SERVICENET INC
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 53 BEACON ST
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City | GREENFIELD
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State | MA
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Zip | 01301-2004
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Country | US
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Telephone | 413-772-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 129 KING ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3258
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF CLINICAL SERVICES
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Name | JAMES BRUCE FRUTKIN
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Credential |
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Telephone | 413-582-9507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0216
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License Number State | MA
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