Basic Information
| Provider Information | |||||||||
| NPI: | 1740594274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CSO | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 29 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010621287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135865555 | ||||||||
| FaxNumber: | 4135862723 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010621287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135865555 | ||||||||
| FaxNumber: | 4135862723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2010 | ||||||||
| LastUpdateDate: | 07/26/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FLEISCHER | ||||||||
| AuthorizedOfficialFirstName: | NICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4135865555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LICSW | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.