Healthcare Provider Details

I. General information

NPI: 1518618230
Provider Name (Legal Business Name): ICSOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 05/20/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 STRATHMORE RD
WORCESTER MA
01610-3414
US

IV. Provider business mailing address

191 E QUASSET RD
WOODSTOCK CT
06281-3307
US

V. Phone/Fax

Practice location:
  • Phone: 617-785-8127
  • Fax:
Mailing address:
  • Phone: 617-785-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
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: ELIAYNE LUPERON
Title or Position: CEO/CLINICIAN
Credential: LADC-1, MFT, MA
Phone: 617-785-8127