Provider Demographics
NPI:1417023672
Name:WILLIAMSTOWN BEHAVIORAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:WILLIAMSTOWN BEHAVIORAL HEALTH ASSOCIATES
Other - Org Name:SIRACUSA ASSOCIATES BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:413-458-9600
Mailing Address - Street 1:681 SIMONDS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267
Mailing Address - Country:US
Mailing Address - Phone:413-458-9600
Mailing Address - Fax:413-458-4028
Practice Address - Street 1:681 SIMONDS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2105
Practice Address - Country:US
Practice Address - Phone:413-458-9600
Practice Address - Fax:413-458-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty