Provider Demographics
NPI:1093882912
Name:BRIGHTSIDE SCHOOL STREET COUNSELING INSTITUTE
Entity Type:Organization
Organization Name:BRIGHTSIDE SCHOOL STREET COUNSELING INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:JANICZEK
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:413-846-4300
Mailing Address - Street 1:33 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1301
Mailing Address - Country:US
Mailing Address - Phone:413-846-4300
Mailing Address - Fax:
Practice Address - Street 1:33 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1301
Practice Address - Country:US
Practice Address - Phone:413-846-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health