Provider Demographics
NPI:1740789767
Name:BATES, DENNIS R (CADC, LADC-I)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:R
Last Name:BATES
Suffix:
Gender:M
Credentials:CADC, LADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-1521
Mailing Address - Country:US
Mailing Address - Phone:413-841-0476
Mailing Address - Fax:
Practice Address - Street 1:1115 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-1521
Practice Address - Country:US
Practice Address - Phone:413-841-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)