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120 Stafford St Worcester MA 01603-1457 | |
| (508) 826-5818 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 Stafford St, Worcester, Massachusetts |
| Authorized Official Name and Position | Grace Mbuya (MANAGER) |
| Authorized Official Contact | 5083447530 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
120 Stafford St Worcester MA 01603-1457 Ph: (508) 826-5818 | 120 Stafford St Worcester MA 01603-1457 Ph: (508) 826-5818 |
| NPI Number | 1114675246 |
|---|---|
| Provider Enumeration Date | 03/17/2022 |
| Last Update Date | 04/20/2023 |
| Certification Date | 04/20/2023 |
| Medicare PECOS PAC ID | 8224576327 |
|---|---|
| Medicare Enrollment ID | O20240821000132 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114675246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Grace Mbuya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104225341 PECOS PAC ID: 1456770551 Enrollment ID: I20201116001004 |
| Provider Name | Margaret Frempong |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508176090 PECOS PAC ID: 8820371107 Enrollment ID: I20240902000252 |
| Provider Name | Magnsnoh Maryanne Nwachuku |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134972052 PECOS PAC ID: 0749721074 Enrollment ID: I20240926000443 |
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