Provider Demographics
NPI:1649759770
Name:SUMMIT ACADEMY, INC.
Entity Type:Organization
Organization Name:SUMMIT ACADEMY, INC.
Other - Org Name:SUMMIT BEHAVIOR SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DIMEZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-751-8500
Mailing Address - Street 1:15 JAMESBURY DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1201
Mailing Address - Country:US
Mailing Address - Phone:508-751-8500
Mailing Address - Fax:508-751-8501
Practice Address - Street 1:15 JAMESBURY DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1201
Practice Address - Country:US
Practice Address - Phone:508-751-8500
Practice Address - Fax:508-751-8501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT ACADEMY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty