| Evergreen Psychotherapy, Llc | |
|
317 State Road Great Barrington MA 01230-1462 | |
| (508) 451-4061 | |
| Not Available |
| Full Name | Evergreen Psychotherapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 317 State Road, Great Barrington, Massachusetts |
| Authorized Official Name and Position | Keith Watkins (OWNER) |
| Authorized Official Contact | 4132747530 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Psychotherapy, Llc 317 State Road Great Barrington MA 01230-1462 Ph: (508) 451-4061 | Evergreen Psychotherapy, Llc 317 State Road Great Barrington MA 01230-1462 Ph: (508) 451-4061 |
| NPI Number | 1437909439 |
|---|---|
| Provider Enumeration Date | 03/25/2024 |
| Last Update Date | 03/25/2024 |
| Certification Date | 03/24/2024 |
| Medicare PECOS PAC ID | 2466894464 |
|---|---|
| Medicare Enrollment ID | O20240522001731 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437909439 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Keith Watkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811775562 PECOS PAC ID: 3072955079 Enrollment ID: I20240522001957 |
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