Provider Demographics
NPI:1396025938
Name:SOUTHEAST COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:SOUTHEAST COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:RAMONDETTA
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-697-1070
Mailing Address - Street 1:1029 PLEASANT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2473
Mailing Address - Country:US
Mailing Address - Phone:339-236-1309
Mailing Address - Fax:
Practice Address - Street 1:1029 PLEASANT ST STE 101
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2473
Practice Address - Country:US
Practice Address - Phone:339-236-1309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114158261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health