Provider Demographics
NPI:1205369014
Name:CLINICAL & SUPPORT OPTIONS
Entity Type:Organization
Organization Name:CLINICAL & SUPPORT OPTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY SUPPORT WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CHERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-233-8742
Mailing Address - Street 1:15 VADNAIS ST
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 VADNAIS ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1934
Practice Address - Country:US
Practice Address - Phone:413-233-8742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization