Healthcare Provider Details

I. General information

NPI: 1629770193
Provider Name (Legal Business Name): NEW ENGLAND CENTER FOR FAMILY CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TYLER PRENTICE RD
WORCESTER MA
01605-1909
US

IV. Provider business mailing address

30 TYLER PRENTICE RD
WORCESTER MA
01605-1909
US

V. Phone/Fax

Practice location:
  • Phone: 508-241-1558
  • Fax:
Mailing address:
  • Phone: 508-241-1558
  • 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 Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBBIE BURWICK
Title or Position: INSURANC/CREDENTIALING SPECIALIST
Credential:
Phone: 774-666-0092