| Full Circle Family Services At White Brook Farm, Llc | |
|
28 Mashamoquet Rd Pomfret Center CT 06259-1813 | |
| (860) 753-6015 | |
| Not Available |
| Full Name | Full Circle Family Services At White Brook Farm, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 28 Mashamoquet Rd, Pomfret Center, Connecticut |
| Authorized Official Name and Position | Lisa Marie Rivera (OWNER) |
| Authorized Official Contact | 8607536015 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Circle Family Services At White Brook Farm, Llc 139 Searles Rd Pomfret Center CT 06259-2305 Ph: (860) 753-6015 | Full Circle Family Services At White Brook Farm, Llc 28 Mashamoquet Rd Pomfret Center CT 06259-1813 Ph: (860) 753-6015 |
| NPI Number | 1326587882 |
|---|---|
| Provider Enumeration Date | 02/16/2017 |
| Last Update Date | 09/11/2023 |
| Certification Date | 09/11/2023 |
| Medicare PECOS PAC ID | 1557646304 |
|---|---|
| Medicare Enrollment ID | O20240228003027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326587882 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 009611 (Connecticut) | Primary |
| Provider Name | Lisa Marie Rivera |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053856989 PECOS PAC ID: 9133404882 Enrollment ID: I20170321002073 |
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