Provider Demographics
NPI:1962577007
Name:WAYSIDE YOUTH AND FAMILY SERVICES
Entity type:Organization
Organization Name:WAYSIDE YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FEE FOR SERVICE CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SIBLEY
Authorized Official - Last Name:SACCHI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-620-0010
Mailing Address - Street 1:51 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1784
Mailing Address - Country:US
Mailing Address - Phone:508-881-7181
Mailing Address - Fax:
Practice Address - Street 1:88 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6354
Practice Address - Country:US
Practice Address - Phone:508-620-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4883251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health