| Gandara Mental Health Center Inc | |
|
2155 Main St Springfield MA 01104 | |
| (413) 736-0395 | |
| (413) 734-1651 |
| Full Name | Gandara Mental Health Center Inc |
|---|---|
| Speciality | Counselor |
| Location | 2155 Main St, Springfield, Massachusetts |
| Authorized Official Name and Position | Henry East-trou (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4137368329 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gandara Mental Health Center Inc 147 Norman St West Springfield MA 01089-5003 Ph: (413) 736-8329 | Gandara Mental Health Center Inc 2155 Main St Springfield MA 01104 Ph: (413) 736-0395 |
| NPI Number | 1134107113 |
|---|---|
| Provider Enumeration Date | 01/09/2006 |
| Last Update Date | 05/02/2013 |
| Medicare PECOS PAC ID | 4486544525 |
|---|---|
| Medicare Enrollment ID | O20040319001118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134107113 | NPI | - | NPPES |
| 1307576 | Medicaid | MA | |
| 1303295 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 217 (Massachusetts) | Primary |
| Provider Name | Pamela B Williams |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1285612804 PECOS PAC ID: 9133101488 Enrollment ID: I20040602000405 |
| Provider Name | Mary E Barkalow |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700864485 PECOS PAC ID: 2668415167 Enrollment ID: I20050606000915 |
| Provider Name | Jose A Flecha |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508844283 PECOS PAC ID: 3274562459 Enrollment ID: I20050808000956 |
| Provider Name | Marjorie Perez Nieves |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699055467 PECOS PAC ID: 4486941135 Enrollment ID: I20160922002234 |
| Provider Name | Monica L O'brien |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639459498 PECOS PAC ID: 9638467483 Enrollment ID: I20161206000511 |
| Provider Name | Audra T Winn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225463334 PECOS PAC ID: 6901142983 Enrollment ID: I20190111001776 |
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