| Relatespace Llc | |
|
75 Arlington St Fl 5 Boston MA 02116-3936 | |
| (617) 366-2550 | |
| Not Available |
| Full Name | Relatespace Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 75 Arlington St Fl 5, Boston, Massachusetts |
| Authorized Official Name and Position | Katherine Lou (SOLE MEMBER AND OWNER) |
| Authorized Official Contact | 6173662550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Relatespace Llc 8709 Bray Vista Way Elk Grove CA 95624-1713 Ph: (617) 366-2550 | Relatespace Llc 75 Arlington St Fl 5 Boston MA 02116-3936 Ph: (617) 366-2550 |
| NPI Number | 1053932046 |
|---|---|
| Provider Enumeration Date | 04/30/2020 |
| Last Update Date | 01/07/2023 |
| Certification Date | 01/07/2023 |
| Medicare PECOS PAC ID | 1658794847 |
|---|---|
| Medicare Enrollment ID | O20200707000464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053932046 | NPI | - | NPPES |
| 110119105A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Katherine Lou |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285085159 PECOS PAC ID: 0244510253 Enrollment ID: I20161209000327 |
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