TEEN CHALLENGE NEW ENGLAND INC NPI 1205307576

NPI Information

NPI: 1205307576
Provider Name: TEEN CHALLENGE NEW ENGLAND INC

Doing Business As: MASSACHUSETTS TC CLINICAL GROUP

Classification: Psychiatry & Neurology - 2084A0401X
Entity Type: Organization

Specialization: Addiction Medicine

Address:
1311 MAIN ST
BROCKTON, MA
ZIP 02301
Phone: (508) 408-4378
Get Directions

TEEN CHALLENGE NEW ENGLAND INC is an addiction medicine psychiatry neurology in Brockton, MA. The provider is a doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine TEEN CHALLENGE NEW ENGLAND INC NPI is 1205307576. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Massachusetts Tc Clinical Group.

The provider's business location address is:

1311 MAIN ST
BROCKTON, MA
ZIP 02301-109
Phone: (508) 408-4378

The provider's authorized official is Jerome Posey .
The authorized official title is Program Director and has the following contact phone number (617) 792-0581.

The enumeration date for this NPI number is 12/16/2018 and was last updated on 12/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	1041C0700X	Social Worker	Clinical			No
2	2084A0401X	Psychiatry & Neurology	Addiction Medicine			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	110158884A	MEDICAID	MASSACHUSETTS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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