Provider Demographics
NPI:1942370382
Name:BRIGHTSIDE SCHOOL STREET COUNSELING INSTITUTE
Entity Type:Organization
Organization Name:BRIGHTSIDE SCHOOL STREET COUNSELING INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANZANO-SICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-846-4300
Mailing Address - Street 1:33 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1301
Mailing Address - Country:US
Mailing Address - Phone:413-846-4300
Mailing Address - Fax:413-732-0429
Practice Address - Street 1:33 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1301
Practice Address - Country:US
Practice Address - Phone:413-846-4300
Practice Address - Fax:413-732-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8301261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASI-W515000Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST