Provider Demographics
NPI:1336493410
Name:BERKSHIRE COUNTY KIDS' PLACE AND VIOLENCE PREVE
Entity Type:Organization
Organization Name:BERKSHIRE COUNTY KIDS' PLACE AND VIOLENCE PREVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-499-2800
Mailing Address - Street 1:63 WENDELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-499-2800
Mailing Address - Fax:413-496-9327
Practice Address - Street 1:63 WENDELL AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-499-2800
Practice Address - Fax:413-496-9327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERKSHIRE COUNTY KIDS' PLACE AND VIOLENCE PREVENTION CENTER, I
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty