Provider Demographics
NPI:1407113624
Name:NORTH SHORE PSYCHIATRY CENTER
Entity Type:Organization
Organization Name:NORTH SHORE PSYCHIATRY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHILD&ADOLESCENT MED. DIR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-922-8600
Mailing Address - Street 1:500 CUMMINGS CENTER
Mailing Address - Street 2:SUITE 5350
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6105
Mailing Address - Country:US
Mailing Address - Phone:978-922-8600
Mailing Address - Fax:978-922-8601
Practice Address - Street 1:500 CUMMINGS CTR
Practice Address - Street 2:SUITE 5350
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6142
Practice Address - Country:US
Practice Address - Phone:978-922-8600
Practice Address - Fax:978-922-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty