Provider Demographics
NPI:1346667466
Name:AMY R OFFENBERG LLC
Entity Type:Organization
Organization Name:AMY R OFFENBERG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:OFFENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW MPH LICSW
Authorized Official - Phone:617-323-2825
Mailing Address - Street 1:16 COHASSET STREET
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131
Mailing Address - Country:US
Mailing Address - Phone:617-323-2825
Mailing Address - Fax:
Practice Address - Street 1:16 COHASSET ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3013
Practice Address - Country:US
Practice Address - Phone:617-323-2825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA118020251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1750513297Medicaid