Basic Information
| Provider Information | |||||||||
| NPI: | 1053845354 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HABIT OPTCO ACADIA HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 CIRCLE AVE | ||||||||
| Address2: | |||||||||
| City: | LYNN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019053050 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 CIRCLE AVE | ||||||||
| Address2: | |||||||||
| City: | LYNN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019053050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7815952413 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2017 | ||||||||
| LastUpdateDate: | 04/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | SULLIVAN | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 7815952413 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | 0801 | MA | Y | Agencies | Public Health or Welfare |
No ID Information.