Provider Demographics
NPI:1003954983
Name:MASSACHUSETTS SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN
Entity type:Organization
Organization Name:MASSACHUSETTS SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:SHAW
Authorized Official - Last Name:WHITEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW
Authorized Official - Phone:413-773-3608
Mailing Address - Street 1:329 CONWAY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1526
Mailing Address - Country:US
Mailing Address - Phone:413-773-3608
Mailing Address - Fax:413-773-9459
Practice Address - Street 1:329 CONWAY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1526
Practice Address - Country:US
Practice Address - Phone:413-773-3608
Practice Address - Fax:413-773-9459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1120001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty