MEDICARE: PARK PLACE COUNSELING INC.

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	7943419	MA

General Provider Information

NPI Number	:	1164646444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK PLACE COUNSELING INC.

Provider Business Mailing Address
First Line	:	352 PARK ST
Second Line	:	SUITE 207 WEST
City	:	NORTH READING
State	:	MA
Zip	:	01864-2164
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	352 PARK ST
Second Line	:	SUITE 207 WEST
City	:	NORTH READING
State	:	MA
Zip	:	01864-2164
Country	:	US
Telephone Number	:	978-664-4228
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOYCE E. DAVIS
Credential	:	LICSW
Telephone Number	:	978-664-4228

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	08/22/2020

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