| Luminosity Behavioral Health Services Inc | |
|
157 Main St Brockton MA 02301-4012 | |
| (781) 344-0102 | |
| (781) 344-1635 |
| Full Name | Luminosity Behavioral Health Services Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 157 Main St, Brockton, Massachusetts |
| Authorized Official Name and Position | Karen D Allen (CEO) |
| Authorized Official Contact | 7813440102 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Luminosity Behavioral Health Services Inc 157 Main St Brockton MA 02301-4012 Ph: (781) 344-0102 | Luminosity Behavioral Health Services Inc 157 Main St Brockton MA 02301-4012 Ph: (781) 344-0102 |
| NPI Number | 1265728521 |
|---|---|
| Provider Enumeration Date | 06/24/2011 |
| Last Update Date | 06/10/2024 |
| Certification Date | 06/10/2024 |
| Medicare PECOS PAC ID | 7618137977 |
|---|---|
| Medicare Enrollment ID | O20120322000614 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265728521 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Massachusetts) | Primary |
| Provider Name | Paulina M Heywood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609950336 PECOS PAC ID: 6103854443 Enrollment ID: I20050728000878 |
| Provider Name | Edith S Pepper |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033428495 PECOS PAC ID: 5890976559 Enrollment ID: I20110301000320 |
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