Healthcare Provider Details

I. General information

NPI: 1588753776
Provider Name (Legal Business Name): CATHERINE OLA THORP PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ELM ST STE 100
WORCESTER MA
01609-1903
US

IV. Provider business mailing address

130 ELM ST STE 100
WORCESTER MA
01609-1903
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-1056
  • Fax: 508-753-1785
Mailing address:
  • Phone: 508-753-1056
  • Fax: 508-753-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number190234
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number190234
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: