Provider Demographics
NPI:1285310078
Name:BERKSHIRE MOUNTAIN CLINIC, LLC
Entity type:Organization
Organization Name:BERKSHIRE MOUNTAIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PATENAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MHS
Authorized Official - Phone:207-798-9725
Mailing Address - Street 1:6 UNIVERSITY DRIVE SUITE 206 #180
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002
Mailing Address - Country:US
Mailing Address - Phone:207-798-9725
Mailing Address - Fax:
Practice Address - Street 1:8 RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035
Practice Address - Country:US
Practice Address - Phone:413-387-0208
Practice Address - Fax:413-387-0380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty