| My Choice Therapy | |
|
21 Hollywood Dr North Grafton MA 01536-1513 | |
| (774) 437-2317 | |
| Not Available |
| Full Name | My Choice Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 21 Hollywood Dr, North Grafton, Massachusetts |
| Authorized Official Name and Position | Gail Bourassa (OWNER) |
| Authorized Official Contact | 7744372317 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Choice Therapy 21 Hollywood Dr North Grafton MA 01536-1513 Ph: (774) 437-2317 | My Choice Therapy 21 Hollywood Dr North Grafton MA 01536-1513 Ph: (774) 437-2317 |
| NPI Number | 1144089087 |
|---|---|
| Provider Enumeration Date | 03/14/2024 |
| Last Update Date | 03/14/2024 |
| Certification Date | 03/14/2024 |
| Medicare PECOS PAC ID | 5496287526 |
|---|---|
| Medicare Enrollment ID | O20241015000855 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144089087 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Gail Bourassa |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417099151 PECOS PAC ID: 4385082635 Enrollment ID: I20240404003583 |
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