Organization
PHOENIX PSYCHIATRIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EWA M. CONROY APRN (OWNER)
(508) 676-5514
Entity
Organization
Contact information
Practice address
101 JEREMIAH SULLIVAN DR, FALL RIVER, MA 02721
(774) 644-5629
(508) 678-8100
Mailing address
3338 N MAIN ST, FALL RIVER, MA 02720-1609
(508) 676-5514
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
206747
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0380130
—
MA
01
—
NP1932
MEDICARE B
MA
Enumeration date
01/06/2012
Last updated
01/06/2012
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