Provider Demographics
NPI:1871845487
Name:SOUTH MIDDLESEX OPPORTUNITY COUNCIL
Entity Type:Organization
Organization Name:SOUTH MIDDLESEX OPPORTUNITY COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUM
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-879-2300
Mailing Address - Street 1:300 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8313
Mailing Address - Country:US
Mailing Address - Phone:508-879-2250
Mailing Address - Fax:508-620-2414
Practice Address - Street 1:300 HOWARD ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8313
Practice Address - Country:US
Practice Address - Phone:508-879-2250
Practice Address - Fax:508-620-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110027995Medicaid