| Empowered Change Pllc | |
|
1515 Hancock St Ste 306 Quincy MA 02169-5244 | |
| (401) 714-3014 | |
| Not Available |
| Full Name | Empowered Change Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1515 Hancock St Ste 306, Quincy, Massachusetts |
| Authorized Official Name and Position | Kate Haworth (OWNER) |
| Authorized Official Contact | 6176455373 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Empowered Change Pllc 1515 Hancock St Ste 306 Quincy MA 02169-5244 Ph: () - | Empowered Change Pllc 1515 Hancock St Ste 306 Quincy MA 02169-5244 Ph: (401) 714-3014 |
| NPI Number | 1851149389 |
|---|---|
| Provider Enumeration Date | 05/09/2024 |
| Last Update Date | 05/09/2024 |
| Certification Date | 05/09/2024 |
| Medicare PECOS PAC ID | 8628507282 |
|---|---|
| Medicare Enrollment ID | O20250128000103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851149389 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Connor Stahl-bryant |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922674415 PECOS PAC ID: 4880031103 Enrollment ID: I20240322001003 |
| Provider Name | Kate A Haworth |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790240943 PECOS PAC ID: 9537698196 Enrollment ID: I20250128000156 |
| Provider Name | Danielle Valenti |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912630054 PECOS PAC ID: 0749719300 Enrollment ID: I20250128000383 |
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