Healthcare Provider Details

I. General information

NPI: 1255562286
Provider Name (Legal Business Name): CAPE ANN COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2009
Last Update Date: 08/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 PROSPECT ST
GLOUCESTER MA
01930-5929
US

IV. Provider business mailing address

61 PROSPECT ST
GLOUCESTER MA
01930-5929
US

V. Phone/Fax

Practice location:
  • Phone: 978-283-9797
  • Fax: 978-283-9797
Mailing address:
  • Phone: 978-283-9797
  • Fax: 978-283-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1032238
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4173
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANIEL F MCMANUS
Title or Position: PSYCHOTHERAPIST
Credential: LMHC, LADCI, CADAC
Phone: 978-283-9797