Healthcare Provider Details

I. General information

NPI: 1386484475
Provider Name (Legal Business Name): RAICES COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 CAMBRIDGE ST
WORCESTER MA
01610-2678
US

IV. Provider business mailing address

404 CAMBRIDGE ST
WORCESTER MA
01610-2678
US

V. Phone/Fax

Practice location:
  • Phone: 508-713-1191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: DR. ERICKA COBOS
Title or Position: OWNER
Credential:
Phone: 508-713-1191