| Youth Opportunities Upheld, Inc. | |
|
135 Gold Star Blvd Worcester MA 01606-2738 | |
| (150) 845-9640 | |
| (508) 849-5618 |
| Full Name | Youth Opportunities Upheld, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 135 Gold Star Blvd, Worcester, Massachusetts |
| Authorized Official Name and Position | David Jordan (PRESIDENT CEO) |
| Authorized Official Contact | 5089831300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Youth Opportunities Upheld, Inc. 135 Gold Star Blvd Worcester MA 01606-2738 Ph: (150) 845-9640 | Youth Opportunities Upheld, Inc. 135 Gold Star Blvd Worcester MA 01606-2738 Ph: (150) 845-9640 |
| NPI Number | 1245317205 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 02/02/2022 |
| Certification Date | 02/02/2022 |
| Medicare PECOS PAC ID | 9638190374 |
|---|---|
| Medicare Enrollment ID | O20051209000469 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245317205 | NPI | - | NPPES |
| 000000034307 | Other | MA | BOSTON MEDICAL CENTER |
| 000000034311 | Other | MA | BOSTON MEDICAL CENTER |
| 311121 | Other | MA | TRICARE |
| 000000034308 | Other | MA | BOSTON MEDICAL CENTER |
| M18588 | Other | MA | BCBSMA |
| 001484 | Other | MA | VALUE OPTIONS |
| 148828000 | Other | MA | CHILDRENS MEDICAL CMSP |
| 000000034309 | Other | MA | BOSTON MEDICAL CENTER |
| 1307665 | Medicaid | MA | |
| 197401000 | Other | MA | CHILDRENS MEDICAL CMSP |
| 7475389 | Other | MA | AETNA |
| 106249 | Other | MA | MAGELLAN |
| 1307665 | Other | MA | MBHP |
| 000000020417 | Other | MA | BOSTON MEDICAL CENTER |
| 00000034310 | Other | MA | BOSTON MEDICAL CENTER |
| 1003280 | Other | MA | BEACON HEALTH STRATEGIES |
| 802801 | Other | MA | TUFTS HEALTH PLAN |
| 197403000 | Other | MA | CHILDRENS MEDICAL CMSP |
| 988587 | Other | MA | NETWORK HEALTH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 4429 (Massachusetts) | Primary |
| Provider Name | Ethel Bullitt |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700833183 PECOS PAC ID: 4284708611 Enrollment ID: I20080804000370 |
| Provider Name | Karen Ann Gemboski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568648483 PECOS PAC ID: 2365594371 Enrollment ID: I20090722000051 |
| Provider Name | Amy Victoria Nichols |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790910073 PECOS PAC ID: 8224280755 Enrollment ID: I20121210000180 |
| Provider Name | Gloria Lee Kazakov |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1730329160 PECOS PAC ID: 9931326659 Enrollment ID: I20140804001404 |
| Provider Name | Kim M Hager |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922327261 PECOS PAC ID: 1355569617 Enrollment ID: I20140827002648 |
| Provider Name | Bethany L Connolly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750448577 PECOS PAC ID: 9032330618 Enrollment ID: I20141023002001 |
| Provider Name | Barbara G Lord |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1619283868 PECOS PAC ID: 0547577074 Enrollment ID: I20150916002139 |
| Provider Name | Joan R Klemm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992130629 PECOS PAC ID: 9739453903 Enrollment ID: I20170927000841 |
| Provider Name | Oliver C Joseph |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023437845 PECOS PAC ID: 8022234525 Enrollment ID: I20180613000881 |
| Provider Name | David C Freeman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124480355 PECOS PAC ID: 2163713082 Enrollment ID: I20200526003089 |
| Provider Name | Allison W. Beckler |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265726558 PECOS PAC ID: 4183921984 Enrollment ID: I20201013000940 |
| Provider Name | Vilmary G Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407226947 PECOS PAC ID: 8527470137 Enrollment ID: I20201223000526 |
| Provider Name | Mary Denman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699296111 PECOS PAC ID: 5698188597 Enrollment ID: I20210114001330 |
| Provider Name | Kasie Iodice |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1033662143 PECOS PAC ID: 8325452642 Enrollment ID: I20210128000609 |
| Provider Name | Xuejing Li |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215342332 PECOS PAC ID: 4587938592 Enrollment ID: I20210311001444 |
| Provider Name | Amy Lynn Vieira |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578989638 PECOS PAC ID: 9638568306 Enrollment ID: I20211118000964 |
| Provider Name | Diana M Mujalli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497175855 PECOS PAC ID: 6901025659 Enrollment ID: I20220719000614 |
| Provider Name | Ryan J Daley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730665266 PECOS PAC ID: 9032582333 Enrollment ID: I20230308000437 |
| Provider Name | Amanda S. Russo Folco |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1730791930 PECOS PAC ID: 2062857501 Enrollment ID: I20240223003552 |
| Provider Name | Tara Burgess |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1487263281 PECOS PAC ID: 8820433295 Enrollment ID: I20240226003164 |
| Provider Name | Molly R Martone |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003239401 PECOS PAC ID: 9931544285 Enrollment ID: I20240227002202 |
| Provider Name | Christina J Breton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003345224 PECOS PAC ID: 1052756129 Enrollment ID: I20240228002365 |
| Provider Name | Rachel A Medrano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295515203 PECOS PAC ID: 0941645865 Enrollment ID: I20240301002432 |
| Provider Name | Nevila B Weagle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104002062 PECOS PAC ID: 4981040565 Enrollment ID: I20240306002610 |
| Provider Name | Sarah L Hine |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679065692 PECOS PAC ID: 2163868258 Enrollment ID: I20240312000978 |
| Provider Name | Samantha Leuschner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457122335 PECOS PAC ID: 2961849765 Enrollment ID: I20240327003795 |
| Provider Name | Katelyn E Hirtle |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1285080911 PECOS PAC ID: 0042651812 Enrollment ID: I20240510000410 |
| Provider Name | Devon A Renfro |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1033567656 PECOS PAC ID: 3577904804 Enrollment ID: I20240516003634 |
| Provider Name | Diane M Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184141632 PECOS PAC ID: 2264874874 Enrollment ID: I20240529000834 |
| Provider Name | Michael A Mcgrath |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1134481542 PECOS PAC ID: 3870035371 Enrollment ID: I20240612002173 |
| Provider Name | Elizabeth L Cuzzupe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649728601 PECOS PAC ID: 3779019708 Enrollment ID: I20241213000294 |
| Provider Name | Katelin A Coughlin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1790203438 PECOS PAC ID: 1456875954 Enrollment ID: I20250407000603 |
| Provider Name | Amy L Roode |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710594759 PECOS PAC ID: 5193118123 Enrollment ID: I20250513000683 |
Olivia Homan, Licsw, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 9 Cedar St, Worcester, MA 01609 Phone: 617-581-2267 | |
Autism Behavioral Health Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 140 Sterling St, Worcester, MA 01610 Phone: 508-321-3055 Fax: 508-321-3055 | |
James P. Bresnahan, P.c. Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 55 Cedar St, Worcester, MA 01609 Phone: 508-752-1170 Fax: 508-752-1800 | |
Community Health Link Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 72 Jaques Ave, Worcester, MA 01610 Phone: 508-438-5578 Fax: 508-860-1023 | |
Guided Growth Therapy Collective Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 24 Falcon St, Worcester, MA 01603 Phone: 508-769-2766 | |
Ld Psych Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 30 Allston Ave, Worcester, MA 01604 Phone: 508-356-4495 | |
Lamacchia Autism Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 31 Granville Ave, Worcester, MA 01606 Phone: 617-974-4908 Fax: 617-974-4908 |