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Addiction Substance Use Disorder

Plymouth, Massachusetts

Provider NPI: 1134118201

Provider Information:
Gender: M

Practice Location:
Tel: 508-667-6704  Fax: 508-747-7470

Business Mailing Address:
Tel: 508-667-6704  Fax: 508-747-7470

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)
X1041C0700XBehavioral Health & Social Service Providers
Social Worker

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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