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General NPI Number Information
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NPI Number | 1780830448
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Entity Type | Organization
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Legal Business Name | SOUTHEAST ADOLESCENT AND ADULT COUNSELING
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 455 W CENTER ST SUITE 3
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City | WEST BRIDGEWATER
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State | MA
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Zip | 02379-1637
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Country | US
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Telephone | 508-954-4431
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Fax |
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Provider Business Mailing Address
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Address Line | 455 W CENTER ST SUITE 3
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City | WEST BRIDGEWATER
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State | MA
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Zip | 02379-1637
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Country | US
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Telephone | 508-954-4431
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MARYLOU SHEARING
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Credential | LICSW
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Telephone | 508-954-4431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 105297
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License Number State | MA
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