Provider Demographics
NPI:1083106520
Name:MOSS BEHAVIORAL HEALTH TREATMENT, INC.
Entity Type:Organization
Organization Name:MOSS BEHAVIORAL HEALTH TREATMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:978-835-5000
Mailing Address - Street 1:374 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-6503
Mailing Address - Country:US
Mailing Address - Phone:978-835-5000
Mailing Address - Fax:978-362-8365
Practice Address - Street 1:374 CONCORD RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-6503
Practice Address - Country:US
Practice Address - Phone:978-835-5000
Practice Address - Fax:978-362-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4241251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000404123OtherBLUE CROSS BLUE SHIELD