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425 Pleasant St Brockton MA 02301-2533 | |
| (617) 694-7172 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 425 Pleasant St, Brockton, Massachusetts |
| Authorized Official Name and Position | Phernel Joseph Manigat (OWNER AND FOUNDER) |
| Authorized Official Contact | 6176947172 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
218 Sawtell Ave Brockton MA 02302-1654 Ph: (617) 694-7172 | 425 Pleasant St Brockton MA 02301-2533 Ph: (617) 694-7172 |
| NPI Number | 1144796491 |
|---|---|
| Provider Enumeration Date | 10/15/2018 |
| Last Update Date | 12/18/2024 |
| Certification Date | 12/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144796491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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