| Life Enhancement Psychotherapy Llc | |
|
427 Columbia Rd Ste 108 Hanover MA 02339 | |
| (617) 552-5124 | |
| Not Available |
| Full Name | Life Enhancement Psychotherapy Llc |
|---|---|
| Speciality | Psychologist |
| Location | 427 Columbia Rd Ste 108, Hanover, Massachusetts |
| Authorized Official Name and Position | Leshelle Woodard (PSYCHOLOGIST) |
| Authorized Official Contact | 6175525124 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Enhancement Psychotherapy Llc Po Box 934 Hanover MA 02339-0934 Ph: (617) 552-5124 | Life Enhancement Psychotherapy Llc 427 Columbia Rd Ste 108 Hanover MA 02339 Ph: (617) 552-5124 |
| NPI Number | 1578862272 |
|---|---|
| Provider Enumeration Date | 03/21/2011 |
| Last Update Date | 07/23/2018 |
| Medicare PECOS PAC ID | 2264602192 |
|---|---|
| Medicare Enrollment ID | O20110831000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578862272 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 8649 (Massachusetts) | Primary |
| 104100000X | Social Worker | 115940 (Massachusetts) | Secondary |
| Provider Name | Leshelle Woodard |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912087776 PECOS PAC ID: 5597765693 Enrollment ID: I20091002000510 |
| Provider Name | Elizabeth T Southall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225211436 PECOS PAC ID: 8729370259 Enrollment ID: I20160701001215 |
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