| Revidas | |
|
108 Grove Street Suite Ll11 Worcester MA 01605-2677 | |
| (508) 304-7499 | |
| (774) 420-7255 |
| Full Name | Revidas |
|---|---|
| Speciality | Counselor |
| Location | 108 Grove Street, Worcester, Massachusetts |
| Authorized Official Name and Position | Geoffrey Cushner (MANAGING DIRECTOR) |
| Authorized Official Contact | 5083047499 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revidas 108 Grove Street Suite Ll11 Worcester MA 01605-2677 Ph: (508) 304-7499 | Revidas 108 Grove Street Suite Ll11 Worcester MA 01605-2677 Ph: (508) 304-7499 |
| NPI Number | 1528410610 |
|---|---|
| Provider Enumeration Date | 07/12/2016 |
| Last Update Date | 10/01/2024 |
| Medicare PECOS PAC ID | 4981177565 |
|---|---|
| Medicare Enrollment ID | O20260625000359 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528410610 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 3875 (Massachusetts) | Primary |
| Provider Name | Geoffrey Cushner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063836997 PECOS PAC ID: 2769760933 Enrollment ID: I20161024001768 |
| Provider Name | Meghan Depatsy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407126196 PECOS PAC ID: 9335612696 Enrollment ID: I20260626004607 |
| Provider Name | Melina Crystal Freeman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386225886 PECOS PAC ID: 0244703528 Enrollment ID: I20260627000396 |
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