Provider Demographics
NPI:1659065571
Name:BLUE SOCIAL EMPOWERMENT AUTISM SERVICES INCORPORTATED
Entity Type:Organization
Organization Name:BLUE SOCIAL EMPOWERMENT AUTISM SERVICES INCORPORTATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MUIRHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:RBT
Authorized Official - Phone:774-245-7739
Mailing Address - Street 1:1 CHACE RD UNIT 14
Mailing Address - Street 2:
Mailing Address - City:EAST FREETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02717-1238
Mailing Address - Country:US
Mailing Address - Phone:774-245-7739
Mailing Address - Fax:508-923-1777
Practice Address - Street 1:1 CHACE RD UNIT 14
Practice Address - Street 2:
Practice Address - City:EAST FREETOWN
Practice Address - State:MA
Practice Address - Zip Code:02717-1238
Practice Address - Country:US
Practice Address - Phone:774-245-7739
Practice Address - Fax:508-923-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health