Provider Demographics
NPI:1386039105
Name:PSYCHED GROUP, LLC
Entity Type:Organization
Organization Name:PSYCHED GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:N
Authorized Official - Last Name:BEAUPRE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:617-657-9838
Mailing Address - Street 1:205 W GROVE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1462
Mailing Address - Country:US
Mailing Address - Phone:800-273-6277
Mailing Address - Fax:888-978-4883
Practice Address - Street 1:205 W GROVE ST STE B2
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1462
Practice Address - Country:US
Practice Address - Phone:617-657-9838
Practice Address - Fax:888-978-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty