| 432 Intentional Therapeutics Inc | |
|
400 Nathan Ellis Hwy Ste B Mashpee MA 02649-3121 | |
| (774) 255-0635 | |
| Not Available |
| Full Name | 432 Intentional Therapeutics Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 400 Nathan Ellis Hwy Ste B, Mashpee, Massachusetts |
| Authorized Official Name and Position | Louisa Gould (OWNER AND PROVIDER) |
| Authorized Official Contact | 7742550635 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 432 Intentional Therapeutics Inc Po Box 56 Falmouth MA 02541-0056 Ph: (774) 255-0635 | 432 Intentional Therapeutics Inc 400 Nathan Ellis Hwy Ste B Mashpee MA 02649-3121 Ph: (774) 255-0635 |
| NPI Number | 1962121772 |
|---|---|
| Provider Enumeration Date | 08/24/2022 |
| Last Update Date | 08/24/2022 |
| Certification Date | 08/24/2022 |
| Medicare PECOS PAC ID | 3678943826 |
|---|---|
| Medicare Enrollment ID | O20230104000238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962121772 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Louisa Gould |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861638801 PECOS PAC ID: 4587961941 Enrollment ID: I20160330000526 |
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