Provider Demographics
NPI:1104275346
Name:DEDHAM CONSULTATION CENTER LLC
Entity type:Organization
Organization Name:DEDHAM CONSULTATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADINO
Authorized Official - Middle Name:
Authorized Official - Last Name:VACCARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-407-7770
Mailing Address - Street 1:339 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1870
Mailing Address - Country:US
Mailing Address - Phone:781-407-7770
Mailing Address - Fax:
Practice Address - Street 1:339 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1870
Practice Address - Country:US
Practice Address - Phone:781-407-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty