| Dorothy Mack, Licsw Llc | |
|
10 Wendell Avenue Ext Ste 209 Pittsfield MA 01201-6283 | |
| (413) 281-0141 | |
| Not Available |
| Full Name | Dorothy Mack, Licsw Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 10 Wendell Avenue Ext Ste 209, Pittsfield, Massachusetts |
| Authorized Official Name and Position | Dorothy Mack (CLINICIAN) |
| Authorized Official Contact | 4132810141 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dorothy Mack, Licsw Llc 10 Wendell Avenue Ext Ste 209 Pittsfield MA 01201-6283 Ph: (413) 281-0141 | Dorothy Mack, Licsw Llc 10 Wendell Avenue Ext Ste 209 Pittsfield MA 01201-6283 Ph: (413) 281-0141 |
| NPI Number | 1578150439 |
|---|---|
| Provider Enumeration Date | 12/28/2020 |
| Last Update Date | 07/02/2021 |
| Certification Date | 06/14/2021 |
| Medicare PECOS PAC ID | 0446657696 |
|---|---|
| Medicare Enrollment ID | O20210930001684 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578150439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Dorothy J Mack |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356623755 PECOS PAC ID: 6002152261 Enrollment ID: I20190108003680 |
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