| Advanced Psych Services, Llc | |
|
425 Lake Ave N Ste 101 Worcester MA 01605 | |
| (508) 753-3220 | |
| (508) 753-3224 |
| Full Name | Advanced Psych Services, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 425 Lake Ave N Ste 101, Worcester, Massachusetts |
| Authorized Official Name and Position | Mohamad R. Och (PRESIDENT) |
| Authorized Official Contact | 5087533220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Psych Services, Llc 425 Lake Ave N Ste 101 Worcester MA 01605-2047 Ph: (508) 753-3220 | Advanced Psych Services, Llc 425 Lake Ave N Ste 101 Worcester MA 01605 Ph: (508) 753-3220 |
| NPI Number | 1750648689 |
|---|---|
| Provider Enumeration Date | 04/17/2012 |
| Last Update Date | 10/21/2020 |
| Certification Date | 09/23/2020 |
| Medicare PECOS PAC ID | 2961667498 |
|---|---|
| Medicare Enrollment ID | O20120706000142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750648689 | NPI | - | NPPES |
| 110094330B | Medicaid | MA | |
| 110094330A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Kimberly A Lovett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720006125 PECOS PAC ID: 2860455060 Enrollment ID: I20041109000452 |
| Provider Name | Oscar Glieberman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477504637 PECOS PAC ID: 3375591159 Enrollment ID: I20050107000791 |
| Provider Name | Jyotsna A Mhatre |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265458806 PECOS PAC ID: 2264488733 Enrollment ID: I20050328000834 |
| Provider Name | Anthony Tabacco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699733535 PECOS PAC ID: 1153359799 Enrollment ID: I20050803000899 |
| Provider Name | Patricia M Senior |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1528089554 PECOS PAC ID: 7416989686 Enrollment ID: I20050908000667 |
| Provider Name | Charanjit S Rao |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1841271301 PECOS PAC ID: 5890705784 Enrollment ID: I20060421000021 |
| Provider Name | Thomas G Chiodetti |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124186986 PECOS PAC ID: 3870684111 Enrollment ID: I20070801000309 |
| Provider Name | Irina Dauphinee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417132259 PECOS PAC ID: 2961565791 Enrollment ID: I20090106000194 |
| Provider Name | Daniel Remillard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295758837 PECOS PAC ID: 6608910179 Enrollment ID: I20100222000513 |
| Provider Name | Ronald C Gobeil |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003926452 PECOS PAC ID: 5294868394 Enrollment ID: I20110707000341 |
| Provider Name | Katherine A Mccloskey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295896702 PECOS PAC ID: 5395976419 Enrollment ID: I20140402001359 |
| Provider Name | Jessica Crawford-grey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457740870 PECOS PAC ID: 7517286701 Enrollment ID: I20150511001356 |
| Provider Name | Frank Vargo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174750830 PECOS PAC ID: 4880900307 Enrollment ID: I20151103002020 |
| Provider Name | Tanille Leana Louis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922541465 PECOS PAC ID: 9234414954 Enrollment ID: I20170321000927 |
| Provider Name | Ryan Paskins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366743403 PECOS PAC ID: 7012171408 Enrollment ID: I20210518000431 |
| Provider Name | Kristina T Vassell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538786645 PECOS PAC ID: 8325444797 Enrollment ID: I20210909003354 |
| Provider Name | Stacie Rose |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871194381 PECOS PAC ID: 5991185282 Enrollment ID: I20220705000537 |
| Provider Name | Bretteney Bianca Hyppolite |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285373506 PECOS PAC ID: 8921483819 Enrollment ID: I20220913002291 |
| Provider Name | Exta Oppong Tweneboa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427766492 PECOS PAC ID: 6103295878 Enrollment ID: I20221220001452 |
| Provider Name | Alyssa Ann Ferland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023743135 PECOS PAC ID: 2668827254 Enrollment ID: I20231017003607 |
| Provider Name | Christian Elizabeth Williams |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336333111 PECOS PAC ID: 1850743576 Enrollment ID: I20240118002081 |
| Provider Name | Steven Bruce Sherman |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164661823 PECOS PAC ID: 4183074867 Enrollment ID: I20240122001356 |
| Provider Name | David Arthur Cloutier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821136235 PECOS PAC ID: 6103279310 Enrollment ID: I20240124001649 |
| Provider Name | Ellen-joan Amick |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1447405634 PECOS PAC ID: 2668825381 Enrollment ID: I20240130001406 |
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