| M.o. L.i.f.e., Inc. | |
|
4 Lambeth Park Dr Fairhaven MA 02719-4734 | |
| (508) 992-5978 | |
| Not Available |
| Full Name | M.o. L.i.f.e., Inc. |
|---|---|
| Speciality | Counselor |
| Location | 4 Lambeth Park Dr, Fairhaven, Massachusetts |
| Authorized Official Name and Position | Ivan Brito (COO) |
| Authorized Official Contact | 7742638897 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M.o. L.i.f.e., Inc. 4 Lambeth Park Dr Fairhaven MA 02719-4734 Ph: (508) 992-5978 | M.o. L.i.f.e., Inc. 4 Lambeth Park Dr Fairhaven MA 02719-4734 Ph: (508) 992-5978 |
| NPI Number | 1801487632 |
|---|---|
| Provider Enumeration Date | 02/03/2021 |
| Last Update Date | 02/03/2021 |
| Certification Date | 02/02/2021 |
| Medicare PECOS PAC ID | 9234500760 |
|---|---|
| Medicare Enrollment ID | O20230120000970 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801487632 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Shawnamarie Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932447570 PECOS PAC ID: 4688043714 Enrollment ID: I20221213001621 |
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