| Community Services Institute, Inc. | |
|
1695 Main St Suite 400 Springfield MA 01103-1348 | |
| (413) 739-5572 | |
| (413) 739-9972 |
| Full Name | Community Services Institute, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1695 Main St, Springfield, Massachusetts |
| Authorized Official Name and Position | Erin Lynn Bonzek (VP OF OPERATIONS) |
| Authorized Official Contact | 4137395572 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Services Institute, Inc. 1695 Main St Ste 400 Springfield MA 01103-1348 Ph: (413) 739-5572 | Community Services Institute, Inc. 1695 Main St Suite 400 Springfield MA 01103-1348 Ph: (413) 739-5572 |
| NPI Number | 1255450631 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 06/29/2023 |
| Certification Date | 06/29/2023 |
| Medicare PECOS PAC ID | 8224192968 |
|---|---|
| Medicare Enrollment ID | O20090126000262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255450631 | NPI | - | NPPES |
| 1004980 | Medicaid | MA | |
| 110027920B | Medicaid | MA | |
| 1303856 | Medicaid | MA | |
| 997648 | Medicaid | MA | |
| M18747 | Other | MA | BCBSMA ID |
| 000000020081 | Medicaid | MA | |
| 110027920A | Medicaid | MA | |
| 1307541 | Medicaid | MA |
| Provider Name | Kiran S Lulla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1316920101 PECOS PAC ID: 7618998097 Enrollment ID: I20051213000556 |
| Provider Name | Christine M Cannon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750602785 PECOS PAC ID: 8022271295 Enrollment ID: I20120525000384 |
| Provider Name | Nathaniel W Pike |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821319922 PECOS PAC ID: 9436313681 Enrollment ID: I20120619000599 |
| Provider Name | Kenneth C Kavanagh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699825919 PECOS PAC ID: 7012941503 Enrollment ID: I20140106001376 |
| Provider Name | Cristen J Sacco-dion |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417278508 PECOS PAC ID: 7416173489 Enrollment ID: I20140728002094 |
| Provider Name | Kristin Hodges |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801205976 PECOS PAC ID: 5395011456 Enrollment ID: I20171018001049 |
| Provider Name | Susan Morgan Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679626378 PECOS PAC ID: 1850631953 Enrollment ID: I20190328000631 |
| Provider Name | Ruben Montanez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316992019 PECOS PAC ID: 4385611136 Enrollment ID: I20200303002233 |
| Provider Name | Sean C Demartino |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205253143 PECOS PAC ID: 9830519271 Enrollment ID: I20201023000412 |
| Provider Name | America Gomez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053822791 PECOS PAC ID: 9830459544 Enrollment ID: I20211110001589 |
| 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 | Brianna L Cook-doughty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912581182 PECOS PAC ID: 4183019284 Enrollment ID: I20220325002223 |
| Provider Name | Anthony Tucci |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285181552 PECOS PAC ID: 3870974058 Enrollment ID: I20220719002867 |
| Provider Name | Idalia Centeno-diaz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225536519 PECOS PAC ID: 3870978794 Enrollment ID: I20220913003638 |
| Provider Name | Frank C Sacco |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245523687 PECOS PAC ID: 0941675672 Enrollment ID: I20230412000792 |
| Provider Name | Elmer Cupino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376518977 PECOS PAC ID: 2062698707 Enrollment ID: I20230816002116 |
| Provider Name | Kelley Ann Macdougall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174844260 PECOS PAC ID: 4688025893 Enrollment ID: I20240111002186 |
| Provider Name | Lisa Anne Mindell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1235657651 PECOS PAC ID: 8224489406 Enrollment ID: I20240111004736 |
| Provider Name | Meg Marie Asselin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1982188496 PECOS PAC ID: 1355784737 Enrollment ID: I20240213003111 |
| Provider Name | Mary Beth Ledoux |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316268493 PECOS PAC ID: 1658725627 Enrollment ID: I20240515000458 |
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