Provider Demographics
NPI:1508185083
Name:CATHOLIC CHARITIES
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-587-0815
Mailing Address - Street 1:686 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2444
Mailing Address - Country:US
Mailing Address - Phone:508-587-0815
Mailing Address - Fax:508-586-9446
Practice Address - Street 1:686 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2444
Practice Address - Country:US
Practice Address - Phone:508-587-0815
Practice Address - Fax:508-586-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health