NPIMap

Organization Active NPI

Teen Challenge New England Inc

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Brockton, MA
National Provider Identifier
1205307576
Registry record updated Dec 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X
Legal business name
TEEN CHALLENGE NEW ENGLAND INC
Doing business as
Massachusetts TC Clinical Group
Practice address
1311 Main St
Brockton, MA 02301-7109
Phone
(508) 408-4378
NPI assigned
Dec 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jerome Posey, M.ED, LADCINPI 1093957185
Title
Program Director
Phone
(617) 792-0581

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X
Addiction Medicine (Psychiatry & Neurology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084A0401X Primary

Addresses

Primary practice location

1311 Main St
Brockton, MA 02301-7109

Mailing address

1311 Main St
Brockton, MA 02301-7109
Phone (508) 408-4378

Other identifiers 1

IdentifierTypeStateIssuer
110158884AMedicaidMA

Other names 1

  • Massachusetts TC Clinical Group Doing business as

National Provider Directory

National Provider Directory

Locations

1305 Main St
Brockton, MA 02301
Phone (508) 256-3238

1315 Main St
Brockton, MA 02301

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608163200000",
    "number": "1205307576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017109",
            "telephone_number": "508-408-4378",
            "fax_number": "508-825-3242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 MAIN ST",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023017109",
            "telephone_number": "508-408-4378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEEN CHALLENGE NEW ENGLAND INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A",
        "authorized_official_last_name": "POSEY",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "617-792-0581",
        "authorized_official_credential": "M.ED, LADCI"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110158884A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Massachusetts TC Clinical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.