| Evergreen Wellness Center, Llc | |
|
171 Highland St Apt 303 Taunton MA 02780-4446 | |
| (508) 386-2094 | |
| (508) 967-7194 |
| Full Name | Evergreen Wellness Center, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 171 Highland St Apt 303, Taunton, Massachusetts |
| Authorized Official Name and Position | Rebecca Nili Uth (MANAGER) |
| Authorized Official Contact | 5083862094 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Wellness Center, Llc Po Box 767 West Warwick RI 02893-0610 Ph: (508) 386-2094 | Evergreen Wellness Center, Llc 171 Highland St Apt 303 Taunton MA 02780-4446 Ph: (508) 386-2094 |
| NPI Number | 1467063875 |
|---|---|
| Provider Enumeration Date | 08/11/2020 |
| Last Update Date | 05/24/2022 |
| Certification Date | 05/24/2022 |
| Medicare PECOS PAC ID | 1153732383 |
|---|---|
| Medicare Enrollment ID | O20201119001931 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467063875 | NPI | - | NPPES |
| 110165840A | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Christina M Fucci |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1487987863 PECOS PAC ID: 3375776321 Enrollment ID: I20140429000971 |
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