Provider Demographics
NPI:1871952242
Name:CHRISTOPHER DONOVAN CENTER, INC.
Entity type:Organization
Organization Name:CHRISTOPHER DONOVAN CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-295-5232
Mailing Address - Street 1:8 MAYFLOWER ROAD
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330
Mailing Address - Country:US
Mailing Address - Phone:508-525-6772
Mailing Address - Fax:
Practice Address - Street 1:4 RECOVERY ROAD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571
Practice Address - Country:US
Practice Address - Phone:508-295-5232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty