Provider Demographics
NPI:1760573034
Name:BARNSTABLE COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BARNSTABLE COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-362-4250
Mailing Address - Street 1:923 ROUTE 6A UNIT N
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2159
Mailing Address - Country:US
Mailing Address - Phone:508-362-4250
Mailing Address - Fax:508-362-5150
Practice Address - Street 1:923 ROUTE 6A UNIT N
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2159
Practice Address - Country:US
Practice Address - Phone:508-362-4250
Practice Address - Fax:508-362-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052471041C0700X
MA1116111041C0700X
MA339342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA605232OtherTUFTS HEALTH PLAN GROUP #
MAM18826OtherBCBS GROUP ID