Provider Demographics
NPI:1740237403
Name:PRIMARY CARE MENTAL HEALTH
Entity Type:Organization
Organization Name:PRIMARY CARE MENTAL HEALTH
Other - Org Name:WILLOW MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRASNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, JD
Authorized Official - Phone:781-593-3480
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:WEST PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7190
Mailing Address - Country:US
Mailing Address - Phone:781-231-7026
Mailing Address - Fax:
Practice Address - Street 1:280 UNION ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1353
Practice Address - Country:US
Practice Address - Phone:781-593-3480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA800310OtherHARVARD PILGRIM HEALTHCAR
MA806117OtherTUFTS HEALTH PLAN
MA9776389Medicaid
MAM16274OtherBLUE CROSS/ BLUE SHIELD
MAM16274OtherBLUE CROSS/ BLUE SHIELD