| Discovery Day Treatment | |
|
460 Quincy Ave Quincy MA 02169-8130 | |
| (617) 847-1950 | |
| Not Available |
| Full Name | Discovery Day Treatment |
|---|---|
| Speciality | Clinic/Center |
| Location | 460 Quincy Ave, Quincy, Massachusetts |
| Authorized Official Name and Position | Minghui Johnson (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6178471950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Discovery Day Treatment 1501 Washington St Braintree MA 02184-7599 Ph: (617) 847-1950 | Discovery Day Treatment 460 Quincy Ave Quincy MA 02169-8130 Ph: (617) 847-1950 |
| NPI Number | 1770528317 |
|---|---|
| Provider Enumeration Date | 06/18/2006 |
| Last Update Date | 06/08/2023 |
| Certification Date | 06/08/2023 |
| Medicare PECOS PAC ID | 4082508429 |
|---|---|
| Medicare Enrollment ID | O20040226000168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770528317 | NPI | - | NPPES |
| 1300989 | Medicaid | MA | |
| 1303155 | Medicaid | MA | |
| 110026069 | Medicaid | MA | |
| 1303937 | Medicaid | MA |
| Provider Name | Renee M Sorrentino |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619968625 PECOS PAC ID: 5193614113 Enrollment ID: I20040315000989 |
| Provider Name | Audrey R Ely |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417989088 PECOS PAC ID: 8628066297 Enrollment ID: I20040503001245 |
| Provider Name | Thomas W Stackhouse |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1124146121 PECOS PAC ID: 2961473293 Enrollment ID: I20040802001080 |
| Provider Name | Marietta G Lyon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598846289 PECOS PAC ID: 9830164789 Enrollment ID: I20040901001498 |
| Provider Name | Lise Memling |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225112436 PECOS PAC ID: 1355309212 Enrollment ID: I20041222000651 |
| Provider Name | Judith E Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740347269 PECOS PAC ID: 3476511866 Enrollment ID: I20050103000214 |
| Provider Name | Richard N Reiner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639194947 PECOS PAC ID: 6002700457 Enrollment ID: I20050324000024 |
| Provider Name | Victoria A Shea |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760415509 PECOS PAC ID: 6709832025 Enrollment ID: I20050329001155 |
| Provider Name | Stephen C Ikeda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619900198 PECOS PAC ID: 0547208795 Enrollment ID: I20050419001187 |
| Provider Name | Justine A Jarosz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336201847 PECOS PAC ID: 1456390327 Enrollment ID: I20050429000331 |
| Provider Name | Philip D Altekruse |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255354049 PECOS PAC ID: 8426097395 Enrollment ID: I20050429000355 |
| Provider Name | Lani J Nicholson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275542920 PECOS PAC ID: 8820038490 Enrollment ID: I20050504000042 |
| Provider Name | Naomi B Dworkin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700844776 PECOS PAC ID: 7113967399 Enrollment ID: I20050506000343 |
| Provider Name | Richard Kurson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740363233 PECOS PAC ID: 4981644176 Enrollment ID: I20050506000393 |
| Provider Name | Kristine M Clasby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659473411 PECOS PAC ID: 7012957160 Enrollment ID: I20050509000081 |
| Provider Name | Esme Blackburn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1427041144 PECOS PAC ID: 5496795502 Enrollment ID: I20050509000495 |
| Provider Name | Bruce E Roberts |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639193683 PECOS PAC ID: 3971543901 Enrollment ID: I20050509000763 |
| Provider Name | Gayle M Patrolia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275623217 PECOS PAC ID: 6507809944 Enrollment ID: I20050607000027 |
| Provider Name | Della L Kaplan |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1023038643 PECOS PAC ID: 2062458805 Enrollment ID: I20050701000724 |
| Provider Name | Constance J Clarke |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1760490544 PECOS PAC ID: 4688602014 Enrollment ID: I20050727001141 |
| Provider Name | Michele Sullivan Grant |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679789994 PECOS PAC ID: 1052349800 Enrollment ID: I20050802000698 |
| Provider Name | Heidemarie S Schliesske |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265589212 PECOS PAC ID: 2668401654 Enrollment ID: I20050810000428 |
| Provider Name | Shaomin Xing |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1700993664 PECOS PAC ID: 0446282347 Enrollment ID: I20050831000201 |
| Provider Name | Maureen A Doyle |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1700804119 PECOS PAC ID: 8628000445 Enrollment ID: I20050901000136 |
| Provider Name | Suzanne L Owens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336212307 PECOS PAC ID: 1052344215 Enrollment ID: I20050917000027 |
| Provider Name | Nancy A Rowley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336245216 PECOS PAC ID: 2567496888 Enrollment ID: I20050926000361 |
| Provider Name | Joyce B Keohan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174539902 PECOS PAC ID: 2860417250 Enrollment ID: I20051014000306 |
| Provider Name | Evelyn J Busnengo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548342439 PECOS PAC ID: 9234155185 Enrollment ID: I20051019001083 |
| Provider Name | Kathleen M Sinar |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1649295957 PECOS PAC ID: 8325065360 Enrollment ID: I20051028000315 |
| Provider Name | Robert Remillard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215011622 PECOS PAC ID: 1052339751 Enrollment ID: I20051110000327 |
| Provider Name | Daniel C Vayda |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316048283 PECOS PAC ID: 9537178819 Enrollment ID: I20060413000672 |
| Provider Name | Dalys A Blair |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841229606 PECOS PAC ID: 9032122544 Enrollment ID: I20060731000388 |
| Provider Name | Thomas A Vautrinot |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912922501 PECOS PAC ID: 7618972407 Enrollment ID: I20061018000321 |
| Provider Name | Arthur L Bence |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457467888 PECOS PAC ID: 5991776791 Enrollment ID: I20070115000116 |
| Provider Name | Allan Giesen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538263991 PECOS PAC ID: 6103828181 Enrollment ID: I20070203000150 |
| Provider Name | Deborah F Grace |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356564199 PECOS PAC ID: 9436255676 Enrollment ID: I20070503000474 |
| Provider Name | Denise D Rajotte |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053458182 PECOS PAC ID: 7113008921 Enrollment ID: I20080423000579 |
| Provider Name | Mary E Gibbons |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942388483 PECOS PAC ID: 5496824443 Enrollment ID: I20080517000024 |
| Provider Name | Paul D Shaw |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184634172 PECOS PAC ID: 5890689244 Enrollment ID: I20080604000023 |
| Provider Name | Cindy K Sprouse |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154308294 PECOS PAC ID: 9436224599 Enrollment ID: I20080825000310 |
| Provider Name | David J Daniels |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548357379 PECOS PAC ID: 5698843852 Enrollment ID: I20081001000606 |
| Provider Name | Maria Jasinskas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134391022 PECOS PAC ID: 3577621465 Enrollment ID: I20081021000802 |
| Provider Name | Debra Bates Washburn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598811762 PECOS PAC ID: 8628135654 Enrollment ID: I20090319000041 |
| Provider Name | John C Dorn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1952351918 PECOS PAC ID: 9638279219 Enrollment ID: I20090416000240 |
| Provider Name | Jeanette E Leaf |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225165665 PECOS PAC ID: 2769530518 Enrollment ID: I20090505000062 |
| Provider Name | Carey A Yeaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528256021 PECOS PAC ID: 3375695380 Enrollment ID: I20090722000028 |
| Provider Name | Donna M Welles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043473275 PECOS PAC ID: 6709924988 Enrollment ID: I20091109000247 |
| Provider Name | Mary Gagne |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1831109040 PECOS PAC ID: 8820094766 Enrollment ID: I20100106000037 |
| Provider Name | Linda Kain-cohen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467779447 PECOS PAC ID: 5294867610 Enrollment ID: I20100721000500 |
| Provider Name | Andres M Chaparro Rincon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609003102 PECOS PAC ID: 8426242009 Enrollment ID: I20101027000968 |
| Provider Name | Emily C Adkins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487845335 PECOS PAC ID: 6305010133 Enrollment ID: I20111114000235 |
| Provider Name | Samantha Oconnell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669674867 PECOS PAC ID: 1850565540 Enrollment ID: I20111115000212 |
| Provider Name | Nicole A Downing |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285889667 PECOS PAC ID: 5092973743 Enrollment ID: I20120227000271 |
| Provider Name | Dwight G Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831309020 PECOS PAC ID: 0446410773 Enrollment ID: I20120324000001 |
| Provider Name | Natalie M Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295823599 PECOS PAC ID: 7911156765 Enrollment ID: I20121011000217 |
| Provider Name | Nikki Lemont |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205065653 PECOS PAC ID: 2264684760 Enrollment ID: I20121207000462 |
| Provider Name | Martha S Root |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730339045 PECOS PAC ID: 2567616063 Enrollment ID: I20130211000188 |
| Provider Name | Barbara S Ellis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467589820 PECOS PAC ID: 2961657440 Enrollment ID: I20130307000306 |
| Provider Name | Meaghan P Hayes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184852238 PECOS PAC ID: 1557503117 Enrollment ID: I20130809000608 |
| Provider Name | Heather J Benak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538390794 PECOS PAC ID: 9931342938 Enrollment ID: I20130823000229 |
| Provider Name | Danielle A Hughes-kruger |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1639493877 PECOS PAC ID: 1557598315 Enrollment ID: I20131226001068 |
| Provider Name | Sarah Van Der Veen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942478417 PECOS PAC ID: 0244468577 Enrollment ID: I20140114000415 |
| Provider Name | Crystal L White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073862876 PECOS PAC ID: 9931339694 Enrollment ID: I20140226000804 |
| Provider Name | Anne Marie Mingolelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063530970 PECOS PAC ID: 6204068158 Enrollment ID: I20140409000026 |
| Provider Name | Kathryn A Greene |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154761344 PECOS PAC ID: 9739305798 Enrollment ID: I20140728001510 |
| Provider Name | Jessica K Morales |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942436241 PECOS PAC ID: 6204056633 Enrollment ID: I20141006002094 |
| Provider Name | Jessica N Allen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538458989 PECOS PAC ID: 7315259512 Enrollment ID: I20150630003003 |
| Provider Name | Sarah Benson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225223373 PECOS PAC ID: 7810202066 Enrollment ID: I20150817001654 |
| Provider Name | Karen M Dangelo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396153623 PECOS PAC ID: 4789974700 Enrollment ID: I20160603000891 |
| Provider Name | Elise A Bocchino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780838904 PECOS PAC ID: 0042591901 Enrollment ID: I20170109000788 |
| Provider Name | Natasha Medeiros |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659636975 PECOS PAC ID: 0345525465 Enrollment ID: I20170331001315 |
| Provider Name | Gillian R Quinn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558700898 PECOS PAC ID: 2365710308 Enrollment ID: I20170616000868 |
| Provider Name | Marinete S Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093241010 PECOS PAC ID: 2961769674 Enrollment ID: I20171206000297 |
| Provider Name | Brian J Mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578018511 PECOS PAC ID: 3779841622 Enrollment ID: I20171222000253 |
| Provider Name | Nicholas Sousa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225542939 PECOS PAC ID: 6305106899 Enrollment ID: I20180131003078 |
| Provider Name | Yvonne C Hitchens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437408713 PECOS PAC ID: 4385906122 Enrollment ID: I20180315000398 |
| Provider Name | Ann T Farr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427501980 PECOS PAC ID: 1951656115 Enrollment ID: I20180612003022 |
| Provider Name | Angela M Clarke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386051621 PECOS PAC ID: 3779835871 Enrollment ID: I20181017001538 |
| Provider Name | Ralph Hemerson De Similien |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013355676 PECOS PAC ID: 9335414010 Enrollment ID: I20190417000707 |
| Provider Name | Emily R Ring |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740662717 PECOS PAC ID: 7416284484 Enrollment ID: I20190814000644 |
| Provider Name | Audrey D Gavin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053609081 PECOS PAC ID: 3870821986 Enrollment ID: I20190828001218 |
| Provider Name | Taixiang Saur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285296632 PECOS PAC ID: 9436481223 Enrollment ID: I20191028002995 |
| Provider Name | Heather A Farmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730512963 PECOS PAC ID: 7517218191 Enrollment ID: I20200214001412 |
| Provider Name | Miranda Simon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801326830 PECOS PAC ID: 8022447895 Enrollment ID: I20200330001593 |
| Provider Name | Purnima Sahgal |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528477361 PECOS PAC ID: 7416386081 Enrollment ID: I20200402000310 |
| Provider Name | Abigail Foley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750781977 PECOS PAC ID: 6800217928 Enrollment ID: I20200528000628 |
| Provider Name | Rebecca L Read |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891305355 PECOS PAC ID: 7416367917 Enrollment ID: I20201112001880 |
| Provider Name | Fallon Shields |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811385586 PECOS PAC ID: 9133528797 Enrollment ID: I20210602000396 |
| Provider Name | Erin Pike |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528586161 PECOS PAC ID: 4880094887 Enrollment ID: I20210614000830 |
| Provider Name | Yelana Loiselle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144731746 PECOS PAC ID: 7315348018 Enrollment ID: I20210701002996 |
| Provider Name | Gail Kundrot |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215122130 PECOS PAC ID: 9830253020 Enrollment ID: I20211013000718 |
| Provider Name | Alycen Palmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306459862 PECOS PAC ID: 5395135834 Enrollment ID: I20211124000620 |
| Provider Name | Andrew Grego |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063176402 PECOS PAC ID: 8527458108 Enrollment ID: I20211214002911 |
| Provider Name | Antonio L Costa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609992916 PECOS PAC ID: 8729470968 Enrollment ID: I20220119002682 |
| Provider Name | Elise W Cohen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003470626 PECOS PAC ID: 6901288562 Enrollment ID: I20220729001800 |
| Provider Name | Elizabeth Scamperle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659994234 PECOS PAC ID: 5294109997 Enrollment ID: I20230321000200 |
| Provider Name | Christina Barrows |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720569049 PECOS PAC ID: 9335585447 Enrollment ID: I20240312001890 |
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