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General NPI Number Information
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NPI Number | 1902227275
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Entity Type | Organization
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Legal Business Name | CORNERSTONE BEHAVIORAL HEALTH INC.
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 30 SEVER ST
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City | WORCESTER
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State | MA
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Zip | 01609-2194
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Country | US
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Telephone | 774-253-1573
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Fax |
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Provider Business Mailing Address
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Address Line | 30 SEVER ST
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City | WORCESTER
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State | MA
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Zip | 01609-2194
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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 | DIRECTOR
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Name | DR. PETER W MORAN
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Credential | PH.D
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Telephone | 774-253-1573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7013
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7534
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6209
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 239917
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7497
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License Number State | MA
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN198309
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License Number State | MA
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Taxonomy #7
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3358
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License Number State | MA
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