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General NPI Number Information
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NPI Number | 1750938171
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Entity Type | Organization
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Legal Business Name | ALPHA RECOVERY SERVICES LLC
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Dates
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Enumeration Date | 08/20/2019
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 16 STEVENS RD
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City | NORTH READING
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State | MA
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Zip | 01864-3216
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Country | US
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Telephone | 617-435-9783
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Fax |
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Provider Business Mailing Address
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Address Line | 16 STEVENS RD
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City | NORTH READING
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State | MA
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Zip | 01864-3216
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Country | US
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Telephone | 617-435-9783
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Fax |
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Authorized Official
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Title or Position | OWNER, OPERATOR
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Name | MATTHEW GANEM
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Credential |
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Telephone | 617-435-9783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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