Provider Demographics
NPI:1013246602
Name:FAMILY COUNSELING ASSOCIATES OF SALEM ANDOVER LLC
Entity type:Organization
Organization Name:FAMILY COUNSELING ASSOCIATES OF SALEM ANDOVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PESCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-605-4986
Mailing Address - Street 1:12 ESSEX ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3728
Mailing Address - Country:US
Mailing Address - Phone:978-886-2359
Mailing Address - Fax:
Practice Address - Street 1:12 ESSEX ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3728
Practice Address - Country:US
Practice Address - Phone:978-886-2359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW 114188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty