Odonata Psychotherapy & Retreat Center Llc | |
121 Main St Buzzards Bay MA 02532 | |
(774) 247-4939 | |
(774) 302-4419 |
Full Name | Odonata Psychotherapy & Retreat Center Llc |
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Speciality | Social Worker - Clinical |
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 |
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Odonata Psychotherapy & Retreat Center Llc 121 Main St Buzzards Bay MA 02532-3245 Ph: (774) 247-4939 | Odonata Psychotherapy & Retreat Center Llc 121 Main St Buzzards Bay MA 02532 Ph: (774) 247-4939 |
NPI Number | 1902285414 |
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Provider Enumeration Date | 05/29/2015 |
Last Update Date | 08/15/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1902285414 | NPI | - | NPPES |
110101319A | Medicaid | MA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | 118383 (Massachusetts) | Primary |
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