Provider Demographics
NPI:1417069410
Name:BROOKSIDE COUNSELING ASSOCIATES LLC
Entity Type:Organization
Organization Name:BROOKSIDE COUNSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ECKELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-749-4600
Mailing Address - Street 1:62 DERBY ST
Mailing Address - Street 2:STE 13
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-749-4600
Mailing Address - Fax:781-741-8341
Practice Address - Street 1:62 DERBY ST
Practice Address - Street 2:STE 13
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-749-4600
Practice Address - Fax:781-741-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA667145OtherTUFTS HEALTH PLANS
MA1005990OtherBEACON HEALTH STRATEGIES
MAP10213OtherBCBS FOR CLINICAL SOCIAL
MAW10414OtherBCBS FOR PSYCHOLOGISTS
MAP10213OtherBCBS FOR CLINICAL SOCIAL