| Reunited | |
|
1354 Hancock St Ste 205 Quincy MA 02169-5109 | |
| (857) 939-4445 | |
| Not Available |
| Full Name | Reunited |
|---|---|
| Speciality | Clinic/Center |
| Location | 1354 Hancock St Ste 205, Quincy, Massachusetts |
| Authorized Official Name and Position | Brandon Gholson (INTAKE COORDINATOR) |
| Authorized Official Contact | 8579394445 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reunited 1354 Hancock St Ste 205 Quincy MA 02169-5109 Ph: (857) 939-4445 | Reunited 1354 Hancock St Ste 205 Quincy MA 02169-5109 Ph: (857) 939-4445 |
| NPI Number | 1124731476 |
|---|---|
| Provider Enumeration Date | 01/03/2023 |
| Last Update Date | 01/26/2023 |
| Certification Date | 01/24/2023 |
| Medicare PECOS PAC ID | 1355713264 |
|---|---|
| Medicare Enrollment ID | O20230202000117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124731476 | NPI | - | NPPES |
| 1366796070 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Brandon Terrell-robert Gholson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639420011 PECOS PAC ID: 4880066794 Enrollment ID: I20230202000171 |
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