| Southeastern Psychiatric Assoc | |
|
1093 N Main St Randolph MA 02368 | |
| (781) 963-7775 | |
| (781) 963-7776 |
| Full Name | Southeastern Psychiatric Assoc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1093 N Main St, Randolph, Massachusetts |
| Authorized Official Name and Position | Dean Solomon (PRESIDENT) |
| Authorized Official Contact | 7819637775 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Psychiatric Assoc 1093 N Main St Randolph MA 02368 Ph: (781) 963-7775 | Southeastern Psychiatric Assoc 1093 N Main St Randolph MA 02368 Ph: (781) 963-7775 |
| NPI Number | 1891771267 |
|---|---|
| Provider Enumeration Date | 12/19/2005 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4486696614 |
|---|---|
| Medicare Enrollment ID | O20050526000818 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891771267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Massachusetts) | Primary |
| Provider Name | Gary M Warstadt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639155013 PECOS PAC ID: 8022065135 Enrollment ID: I20050331001015 |
| Provider Name | Leonard Marcus |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730165119 PECOS PAC ID: 8628025400 Enrollment ID: I20050404000893 |
| Provider Name | Peter J Erines |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972536563 PECOS PAC ID: 6002856531 Enrollment ID: I20050504000671 |
| Provider Name | Daniel Mark Kane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588640585 PECOS PAC ID: 6709814544 Enrollment ID: I20050802000572 |
| Provider Name | Dean Solomon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588641641 PECOS PAC ID: 4385686518 Enrollment ID: I20050826000008 |
| Provider Name | Amy S Kavadlo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629054002 PECOS PAC ID: 5698791697 Enrollment ID: I20051019000602 |
| Provider Name | Krishnaswamy Gajaraj |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962488395 PECOS PAC ID: 7618973454 Enrollment ID: I20061018000325 |
| Provider Name | Evelyn E Hale |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548450687 PECOS PAC ID: 2769575216 Enrollment ID: I20070829000756 |
| Provider Name | Harry Berg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922187822 PECOS PAC ID: 3173610433 Enrollment ID: I20071114000023 |
| Provider Name | Fiona Mudge |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417933888 PECOS PAC ID: 1254512049 Enrollment ID: I20110228000404 |
| Provider Name | Linda Sheppard-reece |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023495538 PECOS PAC ID: 5395047898 Enrollment ID: I20151230000171 |
| Provider Name | Jessica L Kolczewski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740670124 PECOS PAC ID: 0042500910 Enrollment ID: I20160606000749 |
| Provider Name | Jill M Harrison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518192293 PECOS PAC ID: 9739314774 Enrollment ID: I20170127001343 |
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Safe Space Therapeutic Services, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 10 Mazzeo Dr Ste 206, Randolph, MA 02368 Phone: 781-269-2774 Fax: 781-394-8377 | |
Wellness For Our Future, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 73 N Glenway Ave, Randolph, MA 02368 Phone: 857-221-0451 | |
May Institute Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14 Pacella Park Dr, Randolph, MA 02368 Phone: 781-437-1404 |