Provider Demographics
NPI:1598825119
Name:STODDARD ROCKS
Entity Type:Organization
Organization Name:STODDARD ROCKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELTUS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC,LADC-I,CADAC
Authorized Official - Phone:978-365-4966
Mailing Address - Street 1:70 HIGH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-2922
Mailing Address - Country:US
Mailing Address - Phone:978-365-4966
Mailing Address - Fax:
Practice Address - Street 1:70 HIGH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-2922
Practice Address - Country:US
Practice Address - Phone:978-365-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4781251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health