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Organization
MARTHA'S VINEYARD COMMUNITY SERVICES, INC.
Active
Organization
MARTHA'S VINEYARD COMMUNITY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN J STALGREN M.B.A. (BUSINESS ADMINISTRATOR)
(508) 693-7900
Entity
Organization
Contact information
Practice address
111 EDGARTOWN RD, OAK BLUFFS, MA 02557
(508) 693-7900
Mailing address
111 EDGARTOWN RD, VINEYARD HAVEN, MA 02568-5699
(508) 693-7900
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2331
MA
101YM0800X
Mental Health Counselor
2331
MA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1301543
—
MA
05
—
1310143
—
MA
01
—
M18486
BCBSMA PROVIDER #
MA
Enumeration date
07/31/2006
Last updated
10/28/2019
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