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General NPI Number Information
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NPI Number | 1427468107
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Entity Type | Organization
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Legal Business Name | MOTHERS WITH COURAGE
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 1205 HYDE PARK AVE
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City | HYDE PARK
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State | MA
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Zip | 02136-2837
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Country | US
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Telephone | 508-386-6155
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Fax |
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Provider Business Mailing Address
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Address Line | 34 HODGES AVE APT 2
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City | TAUNTON
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State | MA
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Zip | 02780-3051
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Country | US
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Telephone | 508-386-6155
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Fax |
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Authorized Official
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Title or Position | CLINICIAN
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Name | MISS GENEVOR MONELL
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Credential | M.A. EDUCATION
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Telephone | 508-386-6155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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