Provider Demographics
NPI:1265989453
Name:MASSACHUSETTS PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:MASSACHUSETTS PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED
Authorized Official - Prefix:
Authorized Official - First Name:MEENAKSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-418-6888
Mailing Address - Street 1:258 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1540
Mailing Address - Country:US
Mailing Address - Phone:508-418-6888
Mailing Address - Fax:508-418-6886
Practice Address - Street 1:258 MAIN ST
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1540
Practice Address - Country:US
Practice Address - Phone:508-418-6888
Practice Address - Fax:508-418-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty