| Bridge Of Changes | |
|
1985 Main St Ste 305 Springfield MA 01103-1074 | |
| (413) 301-6625 | |
| (413) 301-6825 |
| Full Name | Bridge Of Changes |
|---|---|
| Speciality | Clinic/Center |
| Location | 1985 Main St Ste 305, Springfield, Massachusetts |
| Authorized Official Name and Position | Maria Ivette Santana (CEO) |
| Authorized Official Contact | 4138853965 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge Of Changes 1985 Main St Ste 305 Springfield MA 01103-1074 Ph: (413) 885-3965 | Bridge Of Changes 1985 Main St Ste 305 Springfield MA 01103-1074 Ph: (413) 301-6625 |
| NPI Number | 1710597406 |
|---|---|
| Provider Enumeration Date | 08/06/2020 |
| Last Update Date | 12/17/2020 |
| Certification Date | 12/17/2020 |
| Medicare PECOS PAC ID | 5799190062 |
|---|---|
| Medicare Enrollment ID | O20210218001602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710597406 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Maria Ivette Santana |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851447981 PECOS PAC ID: 3779914858 Enrollment ID: I20200505000441 |
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