Provider Demographics
NPI:1326590332
Name:WALPOLE BEHAVIORAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:WALPOLE BEHAVIORAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:FARNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-660-6699
Mailing Address - Street 1:841 MAIN ST
Mailing Address - Street 2:LL2
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2997
Mailing Address - Country:US
Mailing Address - Phone:508-660-6699
Mailing Address - Fax:508-660-6658
Practice Address - Street 1:841 MAIN ST
Practice Address - Street 2:LL2
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2997
Practice Address - Country:US
Practice Address - Phone:508-660-6699
Practice Address - Fax:508-660-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1141171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty