Provider Demographics
NPI:1689792673
Name:THE PROFESSIONAL COUNSELING CENTER, INC
Entity Type:Organization
Organization Name:THE PROFESSIONAL COUNSELING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-997-0794
Mailing Address - Street 1:466 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5107
Mailing Address - Country:US
Mailing Address - Phone:508-997-0794
Mailing Address - Fax:508-999-6607
Practice Address - Street 1:466 COUNTY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5107
Practice Address - Country:US
Practice Address - Phone:508-997-0794
Practice Address - Fax:508-999-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4362261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305921Medicaid
MA312799OtherVALUE OPTIONS
MA00030147OtherBMC
MA600688OtherTUFTS
MAM18591OtherBLUE CROSS OF MASS
MAY10285Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID