Provider Demographics
NPI:1518570340
Name:SCITUATELIGHT BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:SCITUATELIGHT BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAMBURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-436-8418
Mailing Address - Street 1:630 PARK ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3659
Mailing Address - Country:US
Mailing Address - Phone:781-436-8418
Mailing Address - Fax:
Practice Address - Street 1:630 PARK ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3659
Practice Address - Country:US
Practice Address - Phone:781-436-8418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health