Provider Demographics
NPI:1457746711
Name:STURBRIDGE HUMAN SERVICES, INC
Entity type:Organization
Organization Name:STURBRIDGE HUMAN SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-347-7755
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-0740
Mailing Address - Country:US
Mailing Address - Phone:508-347-7755
Mailing Address - Fax:
Practice Address - Street 1:450 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISKDALE
Practice Address - State:MA
Practice Address - Zip Code:01518-1296
Practice Address - Country:US
Practice Address - Phone:508-347-7755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty