MEDICARE: RIVERSIDE EARLY INTERVENTION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1003241456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE EARLY INTERVENTION

Provider Business Mailing Address
First Line	:	255 HIGHLAND AVE
Second Line	:
City	:	NEEDHAM HEIGHTS
State	:	MA
Zip	:	02494-3023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 HIGHLAND AVE
Second Line	:
City	:	NEEDHAM HEIGHTS
State	:	MA
Zip	:	02494-3023
Country	:	US
Telephone Number	:	781-449-1884
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JOANNE SWEENEY
Credential	:
Telephone Number	:	781-247-7770

Provider Enumeration Date	:	09/04/2013
Last Update Date	:	09/04/2013

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