| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2 Lobster Ln, Chatham, Massachusetts |
| Authorized Official Name and Position | Jessica D'acoasta (OWNER) |
| Authorized Official Contact | 9739223551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
2 Early Red Cir Sandwich MA 02563-2681 Ph: (973) 922-3551 | 2 Lobster Ln Chatham MA 02633-2580 Ph: (917) 825-4088 |
| NPI Number | 1659901445 |
|---|---|
| Provider Enumeration Date | 01/21/2020 |
| Last Update Date | 04/12/2023 |
| Certification Date | 04/12/2023 |
| Medicare PECOS PAC ID | 1850751157 |
|---|---|
| Medicare Enrollment ID | O20230718003644 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659901445 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jessica Lynn D Acosta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053780619 PECOS PAC ID: 5294092524 Enrollment ID: I20230718003628 |