| Dimock Community Services Corp. | |
|
41 Dimock St Roxbury MA 02119-1208 | |
| (617) 442-8800 | |
| (617) 442-4088 |
| Full Name | Dimock Community Services Corp. |
|---|---|
| Speciality | Clinic/Center |
| Location | 41 Dimock St, Roxbury, Massachusetts |
| Authorized Official Name and Position | Peter Gerondeau (CFO/SVP) |
| Authorized Official Contact | 6174428800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dimock Community Services Corp. 55 Dimock Street Roxbury MA 02119 Ph: (617) 442-8800 | Dimock Community Services Corp. 41 Dimock St Roxbury MA 02119-1208 Ph: (617) 442-8800 |
| NPI Number | 1326193269 |
|---|---|
| Provider Enumeration Date | 01/23/2007 |
| Last Update Date | 11/22/2019 |
| Medicare PECOS PAC ID | 4385677038 |
|---|---|
| Medicare Enrollment ID | O20050914000391 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326193269 | NPI | - | NPPES |
| 221862 | Other | MA | MEDICARE UGS |
| 1301241 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Massachusetts) | Primary |
| Provider Name | Xialian Liu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144251349 PECOS PAC ID: 9830134675 Enrollment ID: I20050622001171 |
| Provider Name | Evelyn C Dougherty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861539629 PECOS PAC ID: 8729008867 Enrollment ID: I20051202000763 |
| Provider Name | Kimberly Rawlins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689761421 PECOS PAC ID: 4880605617 Enrollment ID: I20060509000130 |
| Provider Name | John B Carven |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871628115 PECOS PAC ID: 2961506647 Enrollment ID: I20070406000223 |
| Provider Name | Nadia M Valentin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558420182 PECOS PAC ID: 2466559810 Enrollment ID: I20070518000208 |
| Provider Name | Michael Tang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598932097 PECOS PAC ID: 8729259197 Enrollment ID: I20110914000720 |
| Provider Name | Kimberly Bowles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558509299 PECOS PAC ID: 3577726413 Enrollment ID: I20120514000034 |
| Provider Name | Kira Armajani |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326395435 PECOS PAC ID: 8921328667 Enrollment ID: I20150521000390 |
| Provider Name | Michael Soule |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457615924 PECOS PAC ID: 8426203266 Enrollment ID: I20150702000939 |
| Provider Name | David G Pattison |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720198351 PECOS PAC ID: 2264440494 Enrollment ID: I20160226000961 |
| Provider Name | Luis Sanchez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669516357 PECOS PAC ID: 6406161413 Enrollment ID: I20180307000896 |
| Provider Name | Tegan O'neill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740785500 PECOS PAC ID: 3678802386 Enrollment ID: I20190905002092 |
| Provider Name | Jacqueline Fickes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518340785 PECOS PAC ID: 3274864657 Enrollment ID: I20191016001941 |
| Provider Name | Sabiha Zaman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740849959 PECOS PAC ID: 1759719867 Enrollment ID: I20200323002656 |
| Provider Name | Claudia Rizzo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184283012 PECOS PAC ID: 0749691921 Enrollment ID: I20201118003031 |
| Provider Name | Elaine Lebel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770121634 PECOS PAC ID: 3678982303 Enrollment ID: I20210511000776 |
| Provider Name | Julianne E Elofson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598293367 PECOS PAC ID: 1153694369 Enrollment ID: I20210518001682 |
| Provider Name | Sofia Pellon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053980011 PECOS PAC ID: 7113320565 Enrollment ID: I20210723000331 |
| Provider Name | Sundus Mari |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1821437914 PECOS PAC ID: 1850798331 Enrollment ID: I20210927000669 |
| Provider Name | Aderonke Bamgbose Pederson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1396139655 PECOS PAC ID: 2567745318 Enrollment ID: I20210930002257 |
| Provider Name | Diobel N/a Feliz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508459637 PECOS PAC ID: 7315324373 Enrollment ID: I20220512000347 |
| Provider Name | Claralys Gonzalez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922715788 PECOS PAC ID: 6406224328 Enrollment ID: I20221128001969 |
| Provider Name | Michelle Maddex |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952823551 PECOS PAC ID: 6103253810 Enrollment ID: I20230119001735 |
Children's Services Of Roxbury, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 520 Dudley St, Roxbury, MA 02119 Phone: 617-276-4200 | |
Hope House Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8 Farnham St, Roxbury, MA 02119 Phone: 617-971-9360 Fax: 617-971-9366 | |
Children's Services Of Roxbury, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 520 Dudley St, Roxbury, MA 02119 Phone: 617-445-6655 Fax: 617-445-0940 | |
Dimock Early Intervention Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1800 Columbus Ave, Roxbury, MA 02119 Phone: 617-442-8800 Fax: 617-445-0091 | |
Community Caring Clinic Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 55 Warren St, Roxbury, MA 02119 Phone: 617-858-7880 | |
The Osiris Group Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 184 Dudley St, Suite 107ll, Roxbury, MA 02119 Phone: 617-442-2002 Fax: 617-442-4002 | |
Casa Esperanza, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 245 Eustis St, Roxbury, MA 02119 Phone: 617-445-1123 Fax: 617-445-1126 |