Provider Demographics
NPI:1376027102
Name:PEDRICK COUNSELING, LLC
Entity Type:Organization
Organization Name:PEDRICK COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-233-0124
Mailing Address - Street 1:75 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1335
Mailing Address - Country:US
Mailing Address - Phone:508-688-7825
Mailing Address - Fax:
Practice Address - Street 1:1 WALPOLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3315
Practice Address - Country:US
Practice Address - Phone:508-688-7825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)