MEDICARE: TRAILHEAD PSYCHOTHERAPY, 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

General Provider Information

NPI Number	:	1720635865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAILHEAD PSYCHOTHERAPY, LLC

Provider Business Mailing Address
First Line	:	110 N HILLSIDE RD STE 21
Second Line	:
City	:	SOUTH DEERFIELD
State	:	MA
Zip	:	01373-9727
Country	:	US
Telephone Number	:	413-387-8355
Fax Number	:	413-200-3100

Provider Business Practice Location Address
First Line	:	110 N HILLSIDE RD STE 19
Second Line	:
City	:	SOUTH DEERFIELD
State	:	MA
Zip	:	01373-9727
Country	:	US
Telephone Number	:	413-387-8355
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MS. MELISSA L EICH-RICHARDSON
Credential	:	LICSW
Telephone Number	:	413-387-8355

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	09/19/2022

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