Healthcare Provider Details

I. General information

NPI: 1710778980
Provider Name (Legal Business Name): NEUROCLARITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 LINCOLN ST STE 6
WORCESTER MA
01605-2408
US

IV. Provider business mailing address

53 GLOUCESTER ST
PROVIDENCE RI
02908-1409
US

V. Phone/Fax

Practice location:
  • Phone: 401-919-6060
  • Fax:
Mailing address:
  • Phone: 401-919-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: MINDY NGUYEN
Title or Position: MANAGER
Credential:
Phone: 508-981-3480