Healthcare Provider Details

I. General information

NPI: 1881278000
Provider Name (Legal Business Name): NEW VISION MULTICULTURAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 PLANTATION ST APT 1
WORCESTER MA
01604-5057
US

IV. Provider business mailing address

48 PLANTATION ST APT 1
WORCESTER MA
01604-5057
US

V. Phone/Fax

Practice location:
  • Phone: 508-723-6409
  • Fax:
Mailing address:
  • Phone: 508-723-6409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE LUGO
Title or Position: CO-FOUNDER, VICE-PRESIDENT
Credential: PSYD, LP, HSP
Phone: 857-342-2030