Provider Demographics
NPI:1619042496
Name:THE ADD CENTER OF WESTERN MASSACHUSETTS
Entity Type:Organization
Organization Name:THE ADD CENTER OF WESTERN MASSACHUSETTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:I
Authorized Official - Last Name:CLIONSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-734-2800
Mailing Address - Street 1:155 MAPLE STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1828
Mailing Address - Country:US
Mailing Address - Phone:413-734-2800
Mailing Address - Fax:413-739-1652
Practice Address - Street 1:155 MAPLE STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1828
Practice Address - Country:US
Practice Address - Phone:413-734-2800
Practice Address - Fax:413-739-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W10372OtherBCBS OF MA