Provider Demographics
NPI:1861643983
Name:ISLAND COUNSELING CENTER, P.C.
Entity Type:Organization
Organization Name:ISLAND COUNSELING CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:RACHID
Authorized Official - Last Name:OCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-754-1803
Mailing Address - Street 1:22 GREENLEAF FARMS CIR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5000
Mailing Address - Country:US
Mailing Address - Phone:508-754-1803
Mailing Address - Fax:508-792-9713
Practice Address - Street 1:57 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2799
Practice Address - Country:US
Practice Address - Phone:508-825-8270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3017052Medicaid
MA3017052Medicaid
MAJ04234Medicare PIN