Provider Demographics
NPI:1326877465
Name:COMMUNITY COUNSELING OF BRISTOL COUNTY, INC.
Entity type:Organization
Organization Name:COMMUNITY COUNSELING OF BRISTOL COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-977-8052
Mailing Address - Street 1:1 WASHINGTON ST STE 10
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3960
Mailing Address - Country:US
Mailing Address - Phone:508-828-9116
Mailing Address - Fax:508-824-6604
Practice Address - Street 1:1 WASHINGTON ST STE 10
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-828-9116
Practice Address - Fax:508-824-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110028064CMedicaid