Healthcare Provider Details

I. General information

NPI: 1427527373
Provider Name (Legal Business Name): INSTITUTE FOR TRAUMA AND HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 UNION STREET SUITE 101
WORCESTER MA
01608
US

IV. Provider business mailing address

51 UNION STREET SUITE 101
WORCESTER MA
01608
US

V. Phone/Fax

Practice location:
  • Phone: 508-799-6306
  • Fax: 508-799-6935
Mailing address:
  • Phone: 508-799-6306
  • Fax: 508-799-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH J FROHOCK
Title or Position: DIRECTOR
Credential: LMHC.LRC
Phone: 508-799-6306