Provider Demographics
NPI:1972671576
Name:CARITAS NORWOOD HOSTPITAL-PSYCHIATRY-OUTPATIENT
Entity Type:Organization
Organization Name:CARITAS NORWOOD HOSTPITAL-PSYCHIATRY-OUTPATIENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-562-5482
Mailing Address - Street 1:77 WARREN STREET-PROVIDER ENROLLMENT DEPT
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-562-5482
Mailing Address - Fax:617-562-5415
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3487
Practice Address - Country:US
Practice Address - Phone:781-769-4000
Practice Address - Fax:617-562-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1212389Medicaid
MA22-S126Medicare ID - Type Unspecified