Organization
PSYCHOLOGICAL ASSOCIATES OF SOUTHEASTERN MASSACHUSETTS, LLC
Active
Organization
PSYCHOLOGICAL ASSOCIATES OF SOUTHEASTERN MASSACHUSETTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE L CARLSON LICSW (MANAGING PARTNER)
(508) 238-7766
Entity
Organization
Contact information
Practice address
115 MAIN ST, SUITE 2D, NORTH EASTON, MA 02356-1468
(508) 238-7766
(508) 230-5089
Mailing address
115 MAIN ST, SUITE 2D, NORTH EASTON, MA 02356-1468
(508) 238-7766
(508) 230-5089
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
99999
MA
1041C0700X
Clinical Social Worker
99999
MA
2084P0800X
Psychiatry Physician
9999999
MA
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
XXXXXXX
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
170367000
MAGELLAN BEHAVIORAL HEALT
MA
01
—
665748
TUFTS HEALTH PLAN
MA
05
—
9785442
—
MA
01
—
M20575
BC/BS OF MASSACHUSETTS
MA
Enumeration date
07/28/2006
Last updated
08/24/2015
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