Provider Demographics
NPI:1598218000
Name:PYRACOLM THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:PYRACOLM THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-835-7750
Mailing Address - Street 1:24 MECHANIC ST APT 9
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-2515
Mailing Address - Country:US
Mailing Address - Phone:617-835-7750
Mailing Address - Fax:
Practice Address - Street 1:24 MECHANIC ST APT 9
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-2515
Practice Address - Country:US
Practice Address - Phone:617-835-7750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1167571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty