Provider Demographics
NPI:1649661166
Name:GREATER MALDEN BEHAVIORAL HEALTH, INC
Entity type:Organization
Organization Name:GREATER MALDEN BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:781-480-3946
Mailing Address - Street 1:6 PLEASANT ST
Mailing Address - Street 2:SUITE 513
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5100
Mailing Address - Country:US
Mailing Address - Phone:781-480-3946
Mailing Address - Fax:781-480-3952
Practice Address - Street 1:6 PLEASANT ST
Practice Address - Street 2:SUITE 513
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5100
Practice Address - Country:US
Practice Address - Phone:781-480-3946
Practice Address - Fax:781-480-3952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4UJP251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty