Provider Demographics
NPI:1184858508
Name:COMMUNITY COUNSELING OF BRISTOL COUNTY, INC.
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING OF BRISTOL COUNTY, INC.
Other - Org Name:CCBC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:508-977-8100
Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3960
Mailing Address - Country:US
Mailing Address - Phone:508-823-5400
Mailing Address - Fax:508-824-6604
Practice Address - Street 1:19 CEDAR ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3301
Practice Address - Country:US
Practice Address - Phone:508-823-5400
Practice Address - Fax:508-824-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4167251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1307975Medicaid
MAY10320Medicare PIN
MA1307975Medicaid