| Unbounded, Llc | |
|
100 Grove St Ste 307 Worcester MA 01605-2654 | |
| (978) 793-3548 | |
| Not Available |
| Full Name | Unbounded, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 100 Grove St Ste 307, Worcester, Massachusetts |
| Authorized Official Name and Position | Amanda Lee Shaw (OWNER) |
| Authorized Official Contact | 9782061682 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Unbounded, Llc 100 Grove St Ste 307 Worcester MA 01605-2654 Ph: () - | Unbounded, Llc 100 Grove St Ste 307 Worcester MA 01605-2654 Ph: (978) 793-3548 |
| NPI Number | 1295459261 |
|---|---|
| Provider Enumeration Date | 10/03/2022 |
| Last Update Date | 07/31/2023 |
| Certification Date | 07/31/2023 |
| Medicare PECOS PAC ID | 0446624563 |
|---|---|
| Medicare Enrollment ID | O20230313001094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295459261 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amanda Lee Shaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023461381 PECOS PAC ID: 2466851498 Enrollment ID: I20210525001595 |
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