Healthcare Provider Details

I. General information

NPI: 1356103774
Provider Name (Legal Business Name): PRATICO MENTAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 AMHERST ST
WORCESTER MA
01602-2037
US

IV. Provider business mailing address

118 AMHERST ST
WORCESTER MA
01602-2037
US

V. Phone/Fax

Practice location:
  • Phone: 774-314-9278
  • Fax: 774-272-8453
Mailing address:
  • Phone: 774-314-9278
  • Fax: 774-272-8453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE PRATICO
Title or Position: PRESIDENT
Credential: LMHC
Phone: 774-314-9278