Provider Demographics
NPI:1871512814
Name:COOLEY DICKINSON HOSPITAL INC
Entity Type:Organization
Organization Name:COOLEY DICKINSON HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUESEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-582-2212
Mailing Address - Street 1:30 LOCUST ST
Mailing Address - Street 2:P.O. BOX 5001
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2052
Mailing Address - Country:US
Mailing Address - Phone:413-582-2000
Mailing Address - Fax:413-582-2680
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2000
Practice Address - Fax:413-582-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2155273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA900170OtherHARVARD PILGRIM HEALTH PL
MA25114600OtherMERIT BEHAVIORAL HEALTH
MA900390OtherTUFTS OUTPATIENT BEHAV HE
MA1004880OtherBEACON HEALTH
MA001267OtherVALUE OPTIONS
MA000000020630OtherBMC HEALTHNET
MA1010476Medicaid
MA1308823Medicaid
MA1310224Medicaid
MA1004880OtherBEACON HEALTH