Provider Demographics
NPI:1508243247
Name:MARTHA'SVINYARD COMMUNITY SERVICES
Entity Type:Organization
Organization Name:MARTHA'SVINYARD COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTEGRATED CARE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRETSCHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-693-7900
Mailing Address - Street 1:111 EDGARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-5699
Mailing Address - Country:US
Mailing Address - Phone:508-693-7900
Mailing Address - Fax:508-696-0401
Practice Address - Street 1:111 EDGARTOWN RD
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-5699
Practice Address - Country:US
Practice Address - Phone:508-693-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127434261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)