Provider Demographics
NPI:1821676891
Name:START LINE BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:START LINE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FURTADO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:774-217-4558
Mailing Address - Street 1:35 MAIN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1343
Mailing Address - Country:US
Mailing Address - Phone:774-217-4558
Mailing Address - Fax:
Practice Address - Street 1:35 MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1343
Practice Address - Country:US
Practice Address - Phone:774-217-4558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty