Provider Demographics
NPI:1700131570
Name:SSTAR
Entity Type:Organization
Organization Name:SSTAR
Other - Org Name:LIFELINE
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HILARIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:ACDP
Authorized Official - Phone:508-235-5010
Mailing Address - Street 1:1010 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02724-2855
Mailing Address - Country:US
Mailing Address - Phone:508-674-5600
Mailing Address - Fax:
Practice Address - Street 1:1010 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02724-2855
Practice Address - Country:US
Practice Address - Phone:508-674-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDP00454101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty