Provider Demographics
NPI:1891033262
Name:GREENBRIDGE COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:GREENBRIDGE COUNSELING AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-649-2055
Mailing Address - Street 1:269 MIDDLESEX RD
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1078
Mailing Address - Country:US
Mailing Address - Phone:978-649-2055
Mailing Address - Fax:
Practice Address - Street 1:269 MIDDLESEX RD
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-1078
Practice Address - Country:US
Practice Address - Phone:978-649-2055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-19
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110097258AMedicaid
MA110097258AMedicaid