Healthcare Provider Details

I. General information

NPI: 1295494300
Provider Name (Legal Business Name): RETRACE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 EDGEWOOD RD
PITTSFIELD MA
01201-3306
US

IV. Provider business mailing address

20 EDGEWOOD RD
PITTSFIELD MA
01201-3306
US

V. Phone/Fax

Practice location:
  • Phone: 413-446-7217
  • Fax:
Mailing address:
  • Phone: 413-446-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KHADEEJAH HASSAN
Title or Position: OWNER
Credential: LICSW, LPN
Phone: 413-446-7217