MEDICARE: LANDFALL COUNSELING SERVICES, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558659680	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1487112074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDFALL COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	1100 WASHINGTON ST STE 6
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-1662
Country	:	US
Telephone Number	:	339-788-0969
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 WASHINGTON ST STE 6
Second Line	:
City	:	HANOVER
State	:	MA
Zip	:	02339-1662
Country	:	US
Telephone Number	:	339-788-0969
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOTHERAPIST
Name	:	RACHEL COHEN
Credential	:	LICSW
Telephone Number	:	339-788-0969

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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