| Massachusetts Tc Clinical Group | |
|
1311 Main St Brockton MA 02301-7109 | |
| (508) 408-4378 | |
| Not Available |
| Full Name | Massachusetts Tc Clinical Group |
|---|---|
| Speciality | Psychiatry & Neurology - Addiction Medicine |
| Location | 1311 Main St, Brockton, Massachusetts |
| Authorized Official Name and Position | Jerome Posey (PROGRAM DIRECTOR) |
| Authorized Official Contact | 6177920581 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Massachusetts Tc Clinical Group 1311 Main St Brockton MA 02301-7109 Ph: (508) 408-4378 | Massachusetts Tc Clinical Group 1311 Main St Brockton MA 02301-7109 Ph: (508) 408-4378 |
| NPI Number | 1205307576 |
|---|---|
| Provider Enumeration Date | 12/16/2018 |
| Last Update Date | 12/17/2020 |
| Certification Date | 12/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205307576 | NPI | - | NPPES |
| 110158884A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
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