Provider Demographics
NPI:1740594274
Name:CSO
Entity Type:Organization
Organization Name:CSO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-586-5555
Mailing Address - Street 1:29 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1287
Mailing Address - Country:US
Mailing Address - Phone:413-586-5555
Mailing Address - Fax:413-586-2723
Practice Address - Street 1:29 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1287
Practice Address - Country:US
Practice Address - Phone:413-586-5555
Practice Address - Fax:413-586-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health