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6006 Number Four Rd Lowville NY 13367-3309 | |
(315) 220-9525 | |
Not Available |
Full Name | |
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Speciality | Social Worker |
Location | 6006 Number Four Rd, Lowville, New York |
Authorized Official Name and Position | Bianca Boucher (SOLE MEMBER) |
Authorized Official Contact | 3157670865 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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6006 Number Four Rd Lowville NY 13367-3309 Ph: (315) 220-9525 | 6006 Number Four Rd Lowville NY 13367-3309 Ph: (315) 220-9525 |
NPI Number | 1235990508 |
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Provider Enumeration Date | 01/23/2024 |
Last Update Date | 06/18/2024 |
Certification Date | 06/18/2024 |
Medicare PECOS PAC ID | 2062858970 |
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Medicare Enrollment ID | O20240314001021 |
Identifier | Type | State | Issuer |
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1235990508 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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104100000X | Social Worker | (* (Not Available)) | Primary |
Provider Name | Bianca J Boucher |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1104114479 PECOS PAC ID: 4981903796 Enrollment ID: I20160429000360 |
Pathways Counseling Services, Llp Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 5402 Dayan St, Lowville, NY 13367 Phone: 315-804-0303 | |