Provider Demographics
NPI:1487682555
Name:NORTH RIVER COUNSELING, INC.
Entity Type:Organization
Organization Name:NORTH RIVER COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-834-7433
Mailing Address - Street 1:769 PLAIN ST STE I
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2147
Mailing Address - Country:US
Mailing Address - Phone:781-834-7433
Mailing Address - Fax:781-834-7458
Practice Address - Street 1:769 PLAIN ST STE I
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2147
Practice Address - Country:US
Practice Address - Phone:781-834-7433
Practice Address - Fax:781-834-7458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0550101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303767Medicaid
MAM18735OtherBCBS ID
MA1303767OtherVALUE OPTIONS/MBHP ID
MA715005OtherTUFTS ID
MA1303767Medicaid