# SELF

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568814390
- **Authorized official:** LUIS RIVERA (COUNSELOR)
- **Authorized official phone:** (413) 244-5624

## Contact information

- **Practice address:** 19 MERRICK AVE APT 1, SPRINGFIELD, MA 01109-4324
- **Practice address phone:** (413) 244-5624
- **Mailing address:** 19 MERRICK AVE, SPRINGFIELD, MA 01109-4324
- **Mailing address phone:** (413) 244-5624

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/05/2016
- **Last updated:** 07/05/2016