Basic Information
Provider Information
NPI: 1487962171
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHULTZ
FirstName: DARCY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MA, ATR
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 MILL ST APT 3103
Address2:  
City: TIVERTON
State: RI
PostalCode: 028781151
CountryCode: US
TelephoneNumber: 5038534805
FaxNumber:  
Practice Location
Address1: 543 NORTH ST
Address2:  
City: NEW BEDFORD
State: MA
PostalCode: 027402782
CountryCode: US
TelephoneNumber: 5089845566
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/16/2010
LastUpdateDate: 09/16/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


Home