Healthcare Provider Details

I. General information

NPI: 1356171805
Provider Name (Legal Business Name): DOMENIC ROCCO MATTRESS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US

IV. Provider business mailing address

135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US

V. Phone/Fax

Practice location:
  • Phone: 508-459-6400
  • Fax: 508-849-5618
Mailing address:
  • Phone: 508-459-6400
  • Fax: 508-849-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: