Basic Information
| Provider Information | |||||||||
| NPI: | 1285729004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC COUNSELING AND CONSULTATION, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021902435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813356000 | ||||||||
| FaxNumber: | 7813405358 | ||||||||
| Practice Location | |||||||||
| Address1: | 49 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH WEYMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021902435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813356000 | ||||||||
| FaxNumber: | 7813405358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | DIMATTEO | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7813356000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.