Provider Demographics
NPI:1821435488
Name:THOM NEOPONSET VALLEY EARLY INTERVENTION PROGRAM
Entity Type:Organization
Organization Name:THOM NEOPONSET VALLEY EARLY INTERVENTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROYDMA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CEIS/D
Authorized Official - Phone:781-551-0405
Mailing Address - Street 1:58 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056-1418
Mailing Address - Country:US
Mailing Address - Phone:508-954-6800
Mailing Address - Fax:
Practice Address - Street 1:58 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1418
Practice Address - Country:US
Practice Address - Phone:508-954-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7960252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency