Provider Demographics
NPI:1790189439
Name:UNLIMITED BEHAVIORAL HEALTH SERVICES OF MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:UNLIMITED BEHAVIORAL HEALTH SERVICES OF MASSACHUSETTS, LLC
Other - Org Name:UNLIMITED BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CAGS
Authorized Official - Phone:508-510-5940
Mailing Address - Street 1:348 NORTH PEARL STREET
Mailing Address - Street 2:RM 8
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1197
Mailing Address - Country:US
Mailing Address - Phone:508-510-5940
Mailing Address - Fax:508-510-6903
Practice Address - Street 1:348 NORTH PEARL STREET
Practice Address - Street 2:RM
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1197
Practice Address - Country:US
Practice Address - Phone:508-510-5940
Practice Address - Fax:508-510-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health