Healthcare Provider Details

I. General information

NPI: 1457116279
Provider Name (Legal Business Name): DLD-PARELLA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 VINSON ST
WORCESTER MA
01605-3990
US

IV. Provider business mailing address

19 VINSON ST APT 3
WORCESTER MA
01605-3990
US

V. Phone/Fax

Practice location:
  • Phone: 774-441-4501
  • Fax:
Mailing address:
  • Phone: 774-441-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LUIS A DIAZ
Title or Position: CEO
Credential:
Phone: 774-441-4501