Basic Information
| Provider Information | |||||||||
| NPI: | 1679600985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVLIN | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | C. | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 132 WHITE OAK WAY | ||||||||
| Address2: | |||||||||
| City: | NORTH ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027606428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086434676 | ||||||||
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| Practice Location | |||||||||
| Address1: | 70 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027802778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088217777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 113176 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 31133-1 | 01 | RI | BCBS RI | OTHER | 1309161 | 05 | MA | MEDICAID |