Provider Demographics
NPI:1578637740
Name:SOMERS TRUST
Entity Type:Organization
Organization Name:SOMERS TRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOMERS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:978-688-8004
Mailing Address - Street 1:873 TURNPIKE STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-688-8004
Mailing Address - Fax:978-686-8554
Practice Address - Street 1:873 TURNPIKE STREET
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845
Practice Address - Country:US
Practice Address - Phone:978-688-8004
Practice Address - Fax:978-686-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10175Medicare UPIN
W10175Medicare ID - Type Unspecified