Healthcare Provider Details

I. General information

NPI: 1992850663
Provider Name (Legal Business Name): PSYCHIATRY AND FAMILY COUNSELING OF WORCESTER COUNTY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CEDAR ST
WORCESTER MA
01609-2134
US

IV. Provider business mailing address

52 CEDAR ST
WORCESTER MA
01609-2134
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-5191
  • Fax: 508-792-1514
Mailing address:
  • Phone: 508-752-5191
  • Fax: 508-792-1514

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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierM16163 W10305
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBS OF MA
# 2
Identifier1004790
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerFALLON HEALTHCARE
# 3
Identifier612881
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH PLAN
# 4
Identifier056724000
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerMAGELLAN BEHAVIORAL HEALT
# 5
Identifier44047
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerCIGNA

VIII. Authorized Official

Name: DR. KEITH C LEVY
Title or Position: CO DIRECTOR
Credential: M.D.
Phone: 508-752-5191