Provider Demographics
NPI:1750394219
Name:NORTH STAR COUNSELING LLC
Entity type:Organization
Organization Name:NORTH STAR COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-465-5033
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-0376
Mailing Address - Country:US
Mailing Address - Phone:978-465-5033
Mailing Address - Fax:978-465-5034
Practice Address - Street 1:37 1/2 FORRESTER ST
Practice Address - Street 2:PROFESSIONAL BUILDING
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-1938
Practice Address - Country:US
Practice Address - Phone:978-465-5033
Practice Address - Fax:978-465-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10233671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP10379OtherBCBSMA
MAP30162Medicare ID - Type Unspecified