Provider Demographics
NPI:1881978971
Name:WALPOLE BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:WALPOLE BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-668-6053
Mailing Address - Street 1:10 COMMON ST UNIT 64
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-9203
Mailing Address - Country:US
Mailing Address - Phone:508-668-6053
Mailing Address - Fax:508-422-7297
Practice Address - Street 1:841 MAIN ST LL2
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2997
Practice Address - Country:US
Practice Address - Phone:508-668-6053
Practice Address - Fax:508-422-7297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4743103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty