Provider Demographics
NPI: | 1639425317 |
---|---|
Name: | MARTHAS VINEYARD COMMUNITY SERVICES INC. |
Entity Type: | Organization |
Organization Name: | MARTHAS VINEYARD COMMUNITY SERVICES INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICIAN |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JANE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SARNO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSW |
Authorized Official - Phone: | 508-693-7900 |
Mailing Address - Street 1: | 111 EDGARTOWN RD |
Mailing Address - Street 2: | |
Mailing Address - City: | VINEYARD HAVEN |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02568-5601 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 508-693-7900 |
Mailing Address - Fax: | 508-693-7192 |
Practice Address - Street 1: | 111 EDGARTOWN ROAD |
Practice Address - Street 2: | |
Practice Address - City: | VINEYARD HAVEN |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02568 |
Practice Address - Country: | US |
Practice Address - Phone: | 508-693-7900 |
Practice Address - Fax: | 508-693-7192 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-07-31 |
Last Update Date: | 2012-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 261QM0801X | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |