Provider Demographics
NPI:1346276367
Name:BRIGHTSIDE FOR FAMILIES AND CHILDREN
Entity Type:Organization
Organization Name:BRIGHTSIDE FOR FAMILIES AND CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OUT PATIENT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-827-4235
Mailing Address - Street 1:2112 RIVERDALE ST
Mailing Address - Street 2:
Mailing Address - City:W SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1024
Mailing Address - Country:US
Mailing Address - Phone:413-788-7366
Mailing Address - Fax:
Practice Address - Street 1:2112 RIVERDALE ST
Practice Address - Street 2:
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1024
Practice Address - Country:US
Practice Address - Phone:413-788-7366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5502305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service