Organization
NORTHEAST HEATLH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARYLOU E SHEARING LICSW (CLINIC DIRECTOR)
(508) 586-2660
Entity
Organization
Contact information
Practice address
231 MAIN ST, BROCKTON, MA 02301-4342
(508) 586-2660
Mailing address
49 COYLE AVE APT 5, PAWTUCKET, RI 02860-1132
(862) 321-9281
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
09/01/2021
Last updated
09/01/2021
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