Provider Demographics
NPI:1154932879
Name:PCS TELE-BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:PCS TELE-BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER TELEHEALTH P
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:339-987-9735
Mailing Address - Street 1:7 VAN TASSEL DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-2819
Mailing Address - Country:US
Mailing Address - Phone:339-987-9735
Mailing Address - Fax:
Practice Address - Street 1:7 VAN TASSEL DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2819
Practice Address - Country:US
Practice Address - Phone:339-987-9735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO562101Medicaid