| Jeanom Dba Like A Phoenix | |
|
21 Cummings Park Ste 200 Woburn MA 01801-2198 | |
| (781) 305-4086 | |
| (781) 305-4087 |
| Full Name | Jeanom Dba Like A Phoenix |
|---|---|
| Speciality | Counselor |
| Location | 21 Cummings Park Ste 200, Woburn, Massachusetts |
| Authorized Official Name and Position | Mona Gebrael El Hachem (OWNER) |
| Authorized Official Contact | 7815695111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeanom Dba Like A Phoenix 21 Cummings Park Ste 200 Woburn MA 01801-2198 Ph: (781) 305-4086 | Jeanom Dba Like A Phoenix 21 Cummings Park Ste 200 Woburn MA 01801-2198 Ph: (781) 305-4086 |
| NPI Number | 1053944850 |
|---|---|
| Provider Enumeration Date | 02/20/2020 |
| Last Update Date | 10/29/2023 |
| Certification Date | 10/29/2023 |
| Medicare PECOS PAC ID | 6507244381 |
|---|---|
| Medicare Enrollment ID | O20220607002097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053944850 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jennifer L Bellissimo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1578046389 PECOS PAC ID: 7214317346 Enrollment ID: I20220707002100 |
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