| Dedham Consultation Center Llc | |
|
339 Washington St Dedham MA 02026-1870 | |
| (781) 407-7770 | |
| Not Available |
| Full Name | Dedham Consultation Center Llc |
|---|---|
| Speciality | Counselor |
| Location | 339 Washington St, Dedham, Massachusetts |
| Authorized Official Name and Position | Bernadino Vaccaro (OWNER) |
| Authorized Official Contact | 7814077770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dedham Consultation Center Llc 339 Washington St Dedham MA 02026-1870 Ph: (781) 407-7770 | Dedham Consultation Center Llc 339 Washington St Dedham MA 02026-1870 Ph: (781) 407-7770 |
| NPI Number | 1104275346 |
|---|---|
| Provider Enumeration Date | 06/08/2016 |
| Last Update Date | 12/14/2023 |
| Certification Date | 12/14/2023 |
| Medicare PECOS PAC ID | 0749562106 |
|---|---|
| Medicare Enrollment ID | O20170119000457 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104275346 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Bernardino Vaccaro |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538125299 PECOS PAC ID: 5698714871 Enrollment ID: I20050427000665 |
| Provider Name | Gabriella Marciante |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528510310 PECOS PAC ID: 4284911868 Enrollment ID: I20170509000718 |
| Provider Name | Charlotte Alex Maguire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861592313 PECOS PAC ID: 5496005860 Enrollment ID: I20180905002514 |
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