Healthcare Provider Details

I. General information

NPI: 1962708693
Provider Name (Legal Business Name): PATHWAYS COUNSELING AND CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 HOLMES ST FL 2
QUINCY MA
02171-2433
US

IV. Provider business mailing address

97 HOLMES ST FL 2
QUINCY MA
02171-2433
US

V. Phone/Fax

Practice location:
  • Phone: 781-866-9497
  • Fax: 617-770-1174
Mailing address:
  • Phone: 781-866-9497
  • Fax: 617-770-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number112033
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112033
License Number StateMA

VIII. Authorized Official

Name: MS. SAMANTHA MARTINEZ
Title or Position: OWNER/PROGRAM DIRECTOR
Credential: LICSW
Phone: 781-866-9497