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General NPI Number Information
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NPI Number | 1841427101
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Entity Type | Organization
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Legal Business Name | SALEM STREET HEALTHCARE INC
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 285 SALEM ST
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City | LOWELL
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State | MA
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Zip | 01854-3517
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Country | US
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Telephone | 978-452-9229
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Fax | 978-452-3752
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Provider Business Mailing Address
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Address Line | 285 SALEM ST
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City | LOWELL
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State | MA
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Zip | 01854-3517
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Country | US
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Telephone | 978-452-9229
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Fax | 978-452-3752
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | FIDA HASSAN
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Credential | OWNER
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Telephone | 978-452-9229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 230249
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License Number State | MA
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