| Mystic Services, Llc | |
|
47 Water St Ste 202 Mystic CT 06355-2573 | |
| (617) 416-0597 | |
| (860) 415-0018 |
| Full Name | Mystic Services, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 47 Water St Ste 202, Mystic, Connecticut |
| Authorized Official Name and Position | Lauren E St. Amour (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 6174160597 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mystic Services, Llc 11 Joyce St Mystic CT 06355-2947 Ph: (617) 416-0597 | Mystic Services, Llc 47 Water St Ste 202 Mystic CT 06355-2573 Ph: (617) 416-0597 |
| NPI Number | 1720619364 |
|---|---|
| Provider Enumeration Date | 02/02/2020 |
| Last Update Date | 02/02/2020 |
| Certification Date | 02/02/2020 |
| Medicare PECOS PAC ID | 0446687719 |
|---|---|
| Medicare Enrollment ID | O20200226001027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720619364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Lauren St Amour |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659412153 PECOS PAC ID: 9537265756 Enrollment ID: I20081120000404 |
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