Basic Information
Provider Information
NPI: 1700353034
EntityType: 2
ReplacementNPI:  
OrganizationName: BLU SAGE COUNSELING SERVICES, LLC
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Mailing Information
Address1: 4 WATER ST STE 4
Address2:  
City: AMESBURY
State: MA
PostalCode: 019132937
CountryCode: US
TelephoneNumber: 9789928257
FaxNumber:  
Practice Location
Address1: 4-6 WATER ST
Address2: #4
City: AMESBURY
State: MA
PostalCode: 01914
CountryCode: US
TelephoneNumber: 9789928257
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/24/2018
LastUpdateDate: 06/09/2020
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AuthorizedOfficialLastName: DIFRAIA
AuthorizedOfficialFirstName: KATHY
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AuthorizedOfficialTitleorPosition: OWNER / MENTAL HEALTH COUNSELOR
AuthorizedOfficialTelephone: 9789928257
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: LMHC
NPICertificationDate: 06/09/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM0801X  Y Ambulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)

No ID Information.


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