| Organization Name: | PEDIATRIC BEHAVIORAL HEALTH, LLC |
| NPI Number: | 1487779104 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TRACEY GUERTIN (CLINICAL DIRECTOR) |
| Mailing Address: | 148 Worcester St West Boylston |
| State: | MA US |
| Postal Code: | 015831751 |
| Phone Number: | 5088351735 |
| Fax Number: | 5088351736 |
| NPI Enumeration Date: | 03/20/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |