Basic Information
| Provider Information | |||||||||
| NPI: | 1154432342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARE | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 940 | ||||||||
| Address2: | 572 MAIN STREET | ||||||||
| City: | WEST YARMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087750719 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 572 ROUTE 28 UNIT 4 | ||||||||
| Address2: | |||||||||
| City: | WEST YARMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087750719 | ||||||||
| FaxNumber: | 5087755309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 101803 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | P05490 | 01 | BCBS | OTHER |