Provider Demographics
NPI:1578847380
Name:NORTH SHORE CLINICIANS GROUP
Entity Type:Organization
Organization Name:NORTH SHORE CLINICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CARTY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-535-1606
Mailing Address - Street 1:1R NEWBURY STREET SUITE 205
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3864
Mailing Address - Country:US
Mailing Address - Phone:978-535-1606
Mailing Address - Fax:978-535-2550
Practice Address - Street 1:1R NEWBURY ST STE 205
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3816
Practice Address - Country:US
Practice Address - Phone:978-535-1606
Practice Address - Fax:978-535-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty