Provider Demographics
NPI:1205915857
Name:MARBLEHEAD COUNSELING CENTER INC
Entity type:Organization
Organization Name:MARBLEHEAD COUNSELING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-631-8273
Mailing Address - Street 1:66 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945
Mailing Address - Country:US
Mailing Address - Phone:781-631-8273
Mailing Address - Fax:781-631-7264
Practice Address - Street 1:66 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945
Practice Address - Country:US
Practice Address - Phone:781-631-8273
Practice Address - Fax:781-631-7264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1307487Medicaid
MAM20964Medicare ID - Type Unspecified