| Ellen Shaw-smith Licsw Bcn, Llc | |
|
104 Russell St Hadley MA 01035-9570 | |
| (413) 582-0355 | |
| (413) 582-0411 |
| Full Name | Ellen Shaw-smith Licsw Bcn, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 104 Russell St, Hadley, Massachusetts |
| Authorized Official Name and Position | Ellen Michelle Shaw-smith (SOLO CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 4135820355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellen Shaw-smith Licsw Bcn, Llc Po Box 622 Hadley MA 01035-0622 Ph: (413) 582-0355 | Ellen Shaw-smith Licsw Bcn, Llc 104 Russell St Hadley MA 01035-9570 Ph: (413) 582-0355 |
| NPI Number | 1891200770 |
|---|---|
| Provider Enumeration Date | 12/13/2017 |
| Last Update Date | 12/13/2017 |
| Medicare PECOS PAC ID | 1557620994 |
|---|---|
| Medicare Enrollment ID | O20180110003565 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891200770 | NPI | - | NPPES |
| 110081474A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 113030 (Massachusetts) | Primary |
| Provider Name | Ellen M Shaw Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427073725 PECOS PAC ID: 3072554385 Enrollment ID: I20050517000906 |
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