Healthcare Provider Details

I. General information

NPI: 1750912762
Provider Name (Legal Business Name): AGAPE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 01/17/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SKYLINE DR UNIT 21
DRACUT MA
01826
US

IV. Provider business mailing address

20 COMMERCIAL DR STE 2003
DRACUT MA
01826-2837
US

V. Phone/Fax

Practice location:
  • Phone: 603-475-1485
  • Fax:
Mailing address:
  • Phone: 978-935-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IVANA SANINOCENCIO
Title or Position: DIRECTOR
Credential:
Phone: 603-475-1485