| Odonata Psychotherapy & Retreat Center Llc | |
|
121 Main St Buzzards Bay MA 02532 | |
| (774) 247-4939 | |
| Not Available |
| Full Name | Odonata Psychotherapy & Retreat Center Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 121 Main St, Buzzards Bay, Massachusetts |
| Authorized Official Name and Position | Nancy C Wiley (OWNER) |
| Authorized Official Contact | 7742474939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Odonata Psychotherapy & Retreat Center Llc 19 Pine Rd Forestdale MA 02644-1413 Ph: (774) 247-4939 | Odonata Psychotherapy & Retreat Center Llc 121 Main St Buzzards Bay MA 02532 Ph: (774) 247-4939 |
| NPI Number | 1689090862 |
|---|---|
| Provider Enumeration Date | 03/11/2014 |
| Last Update Date | 08/15/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689090862 | NPI | - | NPPES |
| 110101319A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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Odonata Psychotherapy & Retreat Center Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 121 Main St, Buzzards Bay, MA 02532 Phone: 774-247-4939 Fax: 774-302-4419 |