MEDICARE: SWANSEA CENTER FOR PSYCHOTHERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	117033	MA

General Provider Information

NPI Number	:	1467900266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWANSEA CENTER FOR PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	25 MARKET ST
Second Line	:	SUITE 14
City	:	SWANSEA
State	:	MA
Zip	:	02777-3999
Country	:	US
Telephone Number	:	508-379-0150
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MARKET ST
Second Line	:	SUITE 14
City	:	SWANSEA
State	:	MA
Zip	:	02777-3999
Country	:	US
Telephone Number	:	508-379-0150
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	ALLISON LENTINO
Credential	:	LISW
Telephone Number	:	508-379-0150

Provider Enumeration Date	:	09/21/2016
Last Update Date	:	09/21/2016

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