MEDICARE: OUT FOR GOOD, INC.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1447741004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUT FOR GOOD, INC.

Provider Business Mailing Address
First Line	:	302 BURNSIDE AVE
Second Line	:
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-2193
Country	:	US
Telephone Number	:	617-980-8835
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 GRANITE AVE
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-4376
Country	:	US
Telephone Number	:	617-980-8835
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER E. CONWAY
Credential	:	M.ED, LADC 2
Telephone Number	:	617-980-8835

Provider Enumeration Date	:	05/19/2018
Last Update Date	:	03/05/2024

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Directions to “OUT FOR GOOD, INC. ” Practice Location

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