|
| |
|
154 Main St Indian Orchard MA 01151-1131 | |
| (413) 301-2533 | |
| (413) 304-7069 |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 154 Main St, Indian Orchard, Massachusetts |
| Authorized Official Name and Position | Zaida Govan (OWNER) |
| Authorized Official Contact | 4133012533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1042 Berkshire Ave Indian Orchard MA 01151-1367 Ph: (413) 301-2533 | 154 Main St Indian Orchard MA 01151-1131 Ph: (413) 301-2533 |
| NPI Number | 1649954777 |
|---|---|
| Provider Enumeration Date | 06/09/2023 |
| Last Update Date | 07/18/2024 |
| Certification Date | 07/18/2024 |
| Medicare PECOS PAC ID | 9537605530 |
|---|---|
| Medicare Enrollment ID | O20240726000656 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649954777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Zaida I Govan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518047778 PECOS PAC ID: 3971997628 Enrollment ID: I20220223002203 |
Greater New Life Christian Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1323 Worcester St, Indian Orchard, MA 01151 Phone: 413-304-2077 Fax: 413-304-2078 | |
Northeast Therapy & Wellness Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 62 Homestead Ave, Indian Orchard, MA 01151 Phone: 203-606-9083 |