| Actualize Counseling & Nutrition Llc | |
|
30 Standish Rd Arlington MA 02476-7069 | |
| (781) 430-9833 | |
| Not Available |
| Full Name | Actualize Counseling & Nutrition Llc |
|---|---|
| Speciality | Social Worker |
| Location | 30 Standish Rd, Arlington, Massachusetts |
| Authorized Official Name and Position | Lisa Keovongsa (OWNER) |
| Authorized Official Contact | 7814309833 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Actualize Counseling & Nutrition Llc 30 Standish Rd Arlington MA 02476-7069 Ph: (781) 430-9833 | Actualize Counseling & Nutrition Llc 30 Standish Rd Arlington MA 02476-7069 Ph: (781) 430-9833 |
| NPI Number | 1316571136 |
|---|---|
| Provider Enumeration Date | 03/02/2020 |
| Last Update Date | 09/25/2023 |
| Certification Date | 09/25/2023 |
| Medicare PECOS PAC ID | 2567815400 |
|---|---|
| Medicare Enrollment ID | O20240127000165 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316571136 | NPI | - | NPPES |
| Provider Name | Khamphady Keovongsa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194125625 PECOS PAC ID: 6305144338 Enrollment ID: I20231011003180 |
| Provider Name | Lisa Marie Keovongsa |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1750859286 PECOS PAC ID: 3476906314 Enrollment ID: I20240127000200 |
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