MEDICARE: FLOURISH THERAPY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1013649029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOURISH THERAPY CENTER

Provider Business Mailing Address
First Line	:	190 OLD DERBY ST STE 202
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4066
Country	:	US
Telephone Number	:	781-974-4802
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 OLD DERBY ST STE 202
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4066
Country	:	US
Telephone Number	:	781-974-4802
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	GINA CONNOR
Credential	:	LICSW
Telephone Number	:	781-974-4802

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

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Directions to “FLOURISH THERAPY CENTER ” Practice Location

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