Provider Demographics
NPI:1144219551
Name:FAMILY SERVICE ASSOCIATION OF GREATER FALL RIVER, INC.
Entity Type:Organization
Organization Name:FAMILY SERVICE ASSOCIATION OF GREATER FALL RIVER, INC.
Other - Org Name:MENTAL HEALTH & SUBSTANCE ABUSE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-730-1138
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02722-0070
Mailing Address - Country:US
Mailing Address - Phone:508-678-7542
Mailing Address - Fax:508-676-3699
Practice Address - Street 1:151 ROCK ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3201
Practice Address - Country:US
Practice Address - Phone:508-678-7542
Practice Address - Fax:508-676-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANONE101YA0400X
MA4263101YM0800X, 103TC0700X, 104100000X, 1041C0700X, 2084P0800X, 2084P0804X, 364SP0807X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Multi-Specialty
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305441Medicaid
MAY10256Medicare ID - Type Unspecified