Provider Demographics
NPI:1427468107
Name:MOTHERS WITH COURAGE
Entity type:Organization
Organization Name:MOTHERS WITH COURAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:GENEVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MONELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA EDUCATION
Authorized Official - Phone:508-386-6155
Mailing Address - Street 1:34 HODGES AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3051
Mailing Address - Country:US
Mailing Address - Phone:508-386-6155
Mailing Address - Fax:
Practice Address - Street 1:1205 HYDE PARK AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2837
Practice Address - Country:US
Practice Address - Phone:508-386-6155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty