| Community Caring Clinic Llc | |
|
55 Warren St Roxbury MA 02119-3235 | |
| (617) 858-7880 | |
| Not Available |
| Full Name | Community Caring Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 55 Warren St, Roxbury, Massachusetts |
| Authorized Official Name and Position | Abdifatah H Ahmed (PRESIDENT) |
| Authorized Official Contact | 6178587880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Caring Clinic Llc Po Box 190683 Roxbury MA 02119-0013 Ph: (617) 858-7880 | Community Caring Clinic Llc 55 Warren St Roxbury MA 02119-3235 Ph: (617) 858-7880 |
| NPI Number | 1184112377 |
|---|---|
| Provider Enumeration Date | 04/24/2018 |
| Last Update Date | 04/24/2018 |
| Medicare PECOS PAC ID | 6002158987 |
|---|---|
| Medicare Enrollment ID | O20190424001826 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184112377 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Robert A Page |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659391811 PECOS PAC ID: 1456525898 Enrollment ID: I20111121000261 |
| Provider Name | Sagitta Woodman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912408089 PECOS PAC ID: 9436408200 Enrollment ID: I20180828001941 |
| Provider Name | Malia A Weber-parker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548725559 PECOS PAC ID: 7012258122 Enrollment ID: I20190417001991 |
| Provider Name | Austin Enomah Agbonifo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750927489 PECOS PAC ID: 3072929314 Enrollment ID: I20210310002203 |
| Provider Name | Lauren A O'sullivan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508291345 PECOS PAC ID: 7214326149 Enrollment ID: I20211116000979 |
| Provider Name | Benjamin Ocasio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316451339 PECOS PAC ID: 9133595325 Enrollment ID: I20221012003121 |
| Provider Name | Sarah Dolaty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245608447 PECOS PAC ID: 6305200122 Enrollment ID: I20230913000561 |
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