Basic Information
| Provider Information | |||||||||
| NPI: | 1588922512 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPECTRUM HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 68 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017026671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088755801 | ||||||||
| FaxNumber: | 5088728934 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017026671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088755801 | ||||||||
| FaxNumber: | 5088728934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2012 | ||||||||
| LastUpdateDate: | 05/22/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GREENE DAY | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC OFFICE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5088755801 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 101Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor |
No ID Information.