Provider Demographics
NPI:1093995045
Name:MASSACHUSETTS SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN
Entity Type:Organization
Organization Name:MASSACHUSETTS SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-236-5656
Mailing Address - Street 1:53 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4714
Mailing Address - Country:US
Mailing Address - Phone:413-236-5656
Mailing Address - Fax:
Practice Address - Street 1:53 EAGLE ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4714
Practice Address - Country:US
Practice Address - Phone:413-236-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health