| Fathers' Uplift Family Group, Llc | |
|
100a Warren St Boston MA 02119-3209 | |
| (617) 708-0870 | |
| Not Available |
| Full Name | Fathers' Uplift Family Group, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 100a Warren St, Boston, Massachusetts |
| Authorized Official Name and Position | Charles Clayton Daniels (CEO) |
| Authorized Official Contact | 6177080870 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fathers' Uplift Family Group, Llc 100a Warren St Boston MA 02119-3209 Ph: (617) 708-0870 | Fathers' Uplift Family Group, Llc 100a Warren St Boston MA 02119-3209 Ph: (617) 708-0870 |
| NPI Number | 1174975452 |
|---|---|
| Provider Enumeration Date | 07/11/2016 |
| Last Update Date | 07/11/2016 |
| Medicare PECOS PAC ID | 7012334774 |
|---|---|
| Medicare Enrollment ID | O20200827000236 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174975452 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 119702 (Massachusetts) | Primary |
| Provider Name | Charles Clayton Daniels |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891076667 PECOS PAC ID: 0042507253 Enrollment ID: I20160930001651 |
| Provider Name | Johnmark A Mangiameli |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780037747 PECOS PAC ID: 8123374634 Enrollment ID: I20180712002617 |
| Provider Name | Cori Williams |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770054751 PECOS PAC ID: 7315344405 Enrollment ID: I20210915003083 |
| Provider Name | Ashley Doherty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902431455 PECOS PAC ID: 7315344462 Enrollment ID: I20231221003404 |
| Provider Name | Ashley Palacios |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881147619 PECOS PAC ID: 4486097029 Enrollment ID: I20240209003606 |
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