Healthcare Provider Details

I. General information

NPI: 1851135412
Provider Name (Legal Business Name): BERTHA M DANCAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SPRUCE ST
LEOMINSTER MA
01453-3361
US

IV. Provider business mailing address

470 MAIN ST APT 2E
FITCHBURG MA
01420-8051
US

V. Phone/Fax

Practice location:
  • Phone: 978-490-5616
  • Fax:
Mailing address:
  • Phone: 978-490-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: