Provider Demographics
NPI:1154457422
Name:PLYMOUTH COUNTY BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:PLYMOUTH COUNTY BEHAVIORAL HEALTH LLC
Other - Org Name:THE PLYMOUTH CENTER FOR BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:508-830-0012
Mailing Address - Street 1:81 SAMOSET ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4500
Mailing Address - Country:US
Mailing Address - Phone:508-830-0012
Mailing Address - Fax:
Practice Address - Street 1:81 SAMOSET ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4500
Practice Address - Country:US
Practice Address - Phone:085-830-0012
Practice Address - Fax:508-830-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M21909OtherIDK
M21909OtherSOCIAL WORKERS