Provider Demographics
NPI:1780830448
Name:SOUTHEAST ADOLESCENT AND ADULT COUNSELING
Entity type:Organization
Organization Name:SOUTHEAST ADOLESCENT AND ADULT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARYLOU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARING
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-954-4431
Mailing Address - Street 1:455 W CENTER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1637
Mailing Address - Country:US
Mailing Address - Phone:508-954-4431
Mailing Address - Fax:
Practice Address - Street 1:455 W CENTER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1637
Practice Address - Country:US
Practice Address - Phone:508-954-4431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1005325OtherFALLON COMMUNITY HEALTH PLAN
109603OtherBLUE CROSS/ BLUE SHIELD HMO
2078990OtherCIGNA
P04466OtherBLUE CROSS/BLUE SHIELD
1005325OtherNEIGHBORHOOD HEALTH PLAN
007377OtherHARVARD PILGRIM HEALTHCARE
453450OtherTUFTS
P04466OtherBLUE CROSS/BLUE SHIELD