Provider Demographics
NPI:1023346947
Name:CLINICAL AND SUPPORT OPTIONS
Entity type:Organization
Organization Name:CLINICAL AND SUPPORT OPTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:AUBUCHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-586-3757
Mailing Address - Street 1:17 NEW SOUTH STREET SUITE 116
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-566-3757
Mailing Address - Fax:413-582-1807
Practice Address - Street 1:17 NEW SOUTH ST STE 116
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4075
Practice Address - Country:US
Practice Address - Phone:415-582-0471
Practice Address - Fax:413-582-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023212251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
330402193OtherBHL