Organization
MEDOPTIONS OF MASSACHUSETTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA DOOLEY (CFO)
(800) 370-3651
Entity
Organization
Contact information
Practice address
84 STATE ST, SUITE 660, BOSTON, MA 02109-2202
(410) 832-2279
(860) 510-0020
Mailing address
55 HATCHETTS HILL RD, OLD LYME, CT 06371-1534
(800) 370-3651
(877) 515-7147
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
163WG0600X
Gerontology Registered Nurse
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
—
2084N0400X
Neurology Physician
—
—
2084N0600X
Clinical Neurophysiology Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
363A00000X
Physician Assistant
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7001000W10663
BLUE CROSS BLUE SHIELD
MA
05
—
9793640
—
MA
01
—
DG1569
PALMETO / RAILROAD MEDICARE
MA
Enumeration date
05/15/2007
Last updated
08/30/2016
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