| Radiance Innovative Services, Llc | |
|
880 Asylum Ave Hartford CT 06105-1902 | |
| (860) 817-8640 | |
| Not Available |
| Full Name | Radiance Innovative Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 880 Asylum Ave, Hartford, Connecticut |
| Authorized Official Name and Position | Charles A. Frazier (OWNER) |
| Authorized Official Contact | 8608178640 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiance Innovative Services, Llc Po Box 154 Hartford CT 06141-0154 Ph: (860) 817-8640 | Radiance Innovative Services, Llc 880 Asylum Ave Hartford CT 06105-1902 Ph: (860) 817-8640 |
| NPI Number | 1942589189 |
|---|---|
| Provider Enumeration Date | 08/05/2011 |
| Last Update Date | 08/05/2011 |
| Medicare PECOS PAC ID | 0244555746 |
|---|---|
| Medicare Enrollment ID | O20150204000301 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942589189 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 006114 (Connecticut) | Primary |
| Provider Name | Charles A Frazier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427462852 PECOS PAC ID: 2961727466 Enrollment ID: I20150204000388 |
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