Provider Demographics
NPI:1588710156
Name:THE HOME FOR LITTLE WANDERS, LONGVIEW FARM
Entity type:Organization
Organization Name:THE HOME FOR LITTLE WANDERS, LONGVIEW FARM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MHC
Authorized Official - Phone:508-668-7703
Mailing Address - Street 1:399 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1218
Mailing Address - Country:US
Mailing Address - Phone:508-668-7703
Mailing Address - Fax:508-660-9639
Practice Address - Street 1:399 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1218
Practice Address - Country:US
Practice Address - Phone:508-668-7703
Practice Address - Fax:508-660-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness