| Living Water Counseling Center Inc | |
|
476 Appleton St Ste 2 Holyoke MA 01040-3236 | |
| (413) 315-3194 | |
| (413) 322-8404 |
| Full Name | Living Water Counseling Center Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 476 Appleton St Ste 2, Holyoke, Massachusetts |
| Authorized Official Name and Position | Frank H Wotton (CEO) |
| Authorized Official Contact | 4132756368 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Living Water Counseling Center Inc 94 Suffolk St Holyoke MA 01040-4458 Ph: (413) 315-3194 | Living Water Counseling Center Inc 476 Appleton St Ste 2 Holyoke MA 01040-3236 Ph: (413) 315-3194 |
| NPI Number | 1174957823 |
|---|---|
| Provider Enumeration Date | 08/29/2013 |
| Last Update Date | 07/28/2020 |
| Certification Date | 07/28/2020 |
| Medicare PECOS PAC ID | 2365676707 |
|---|---|
| Medicare Enrollment ID | O20131017001829 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174957823 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 4TYZ (Massachusetts) | Primary |
| Provider Name | Sharlene C Hernandez |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1316086200 PECOS PAC ID: 1456344910 Enrollment ID: I20040408000506 |
| Provider Name | Aisik Newman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679644751 PECOS PAC ID: 8527014810 Enrollment ID: I20050330000297 |
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