Basic Information
| Provider Information | |||||||||
| NPI: | 1659314425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SERVICENET INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 OLANDER DR | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010603631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135851300 | ||||||||
| FaxNumber: | 4135851323 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 PLEASANT ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010603909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135846855 | ||||||||
| FaxNumber: | 4135851355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 08/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | SACCENTO | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | CIO | ||||||||
| AuthorizedOfficialTelephone: | 4133871151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1302086 | 05 | MA | MEDICAID | M18460 | 01 | MA | BLUE CROSS / BLUE SHIELD | OTHER | 16321 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 716922 | 01 | MA | TUFTS | OTHER |