Provider Demographics
NPI:1083074348
Name:WESTERN MASS PROFESSIONAL GROUP
Entity Type:Organization
Organization Name:WESTERN MASS PROFESSIONAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:413-250-0830
Mailing Address - Street 1:175 DWIGHT RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1576
Mailing Address - Country:US
Mailing Address - Phone:413-250-0830
Mailing Address - Fax:
Practice Address - Street 1:175 DWIGHT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1576
Practice Address - Country:US
Practice Address - Phone:413-250-0830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8739101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty