Healthcare Provider Details

I. General information

NPI: 1366502080
Provider Name (Legal Business Name): CAPE COD COUNSELING ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 ROUTE 149 A2
MARSTONS MILLS MA
02648-1836
US

IV. Provider business mailing address

PO BOX 1053
MARSTONS MILLS MA
02648-5053
US

V. Phone/Fax

Practice location:
  • Phone: 508-428-1811
  • Fax:
Mailing address:
  • Phone: 508-428-1812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113009
License Number StateMA

VIII. Authorized Official

Name: WENDY CROCKER
Title or Position: OWNER
Credential: LICSW
Phone: 508-428-1811