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NPI Code Detail

MEDICARE: EAST SIDE COUNSELING SERVICES, LLC

MEDICARE: EAST SIDE COUNSELING SERVICES, LLC
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
11041C0700XClinical Social Worker1028438MA

General Provider Information

NPI Number : 1902141179
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST SIDE COUNSELING SERVICES, LLC
Provider Business Mailing Address
First Line : 1311 BEDFORD ST.
Second Line :
City : FALL RIVE, MA
State : MA
Zip : 02723
Country : US
Telephone Number : 508-567-1477
Fax Number : 598-567-6494
Provider Business Practice Location Address
First Line : 1311 BEDFORD ST
Second Line :
City : FALL RIVER
State : MA
Zip : 02723-2637
Country : US
Telephone Number : 508-567-1477
Fax Number : 508-567-6494
Authorized Official
Title or Position : MANAGER
Name : MS. MARY R. CRUZ
Credential : LICSW
Telephone Number : 508-567-1477
Provider Enumeration Date : 11/29/2012
Last Update Date : 08/01/2013

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Directions to “EAST SIDE COUNSELING SERVICES, LLC ” Practice Location

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