| Clear Space Mh, Llc | |
|
212 Calla St Providence RI 02905 | |
| (401) 376-3093 | |
| Not Available |
| Full Name | Clear Space Mh, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 212 Calla St, Providence, Rhode Island |
| Authorized Official Name and Position | Alicia V Rodriguez (OWNER) |
| Authorized Official Contact | 4013763093 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clear Space Mh, Llc 555 N Main St # 1171 Providence RI 02904-5722 Ph: (401) 376-3093 | Clear Space Mh, Llc 212 Calla St Providence RI 02905 Ph: (401) 376-3093 |
| NPI Number | 1740918028 |
|---|---|
| Provider Enumeration Date | 08/12/2022 |
| Last Update Date | 05/25/2023 |
| Certification Date | 05/25/2023 |
| Medicare PECOS PAC ID | 1850762840 |
|---|---|
| Medicare Enrollment ID | O20230131000808 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740918028 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lucely D Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093160558 PECOS PAC ID: 0941598767 Enrollment ID: I20161011002640 |
| Provider Name | Alicia Vanessa Rodriguez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487206199 PECOS PAC ID: 5597097535 Enrollment ID: I20191024001802 |
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