Provider Demographics
NPI:1558543439
Name:MATHIEU BERMINGHAM DBA CENTER FOR WELL BEING
Entity Type:Organization
Organization Name:MATHIEU BERMINGHAM DBA CENTER FOR WELL BEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-376-6018
Mailing Address - Street 1:142 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1212
Mailing Address - Country:US
Mailing Address - Phone:508-376-6018
Mailing Address - Fax:508-376-6070
Practice Address - Street 1:142 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1212
Practice Address - Country:US
Practice Address - Phone:508-376-6018
Practice Address - Fax:508-376-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219888261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1862651Medicaid