Facts
- Status
- A
- Credential
- LMHC
- Type
- Individual
- Enumeration date
- 2022-08-02
- Last updated
- 2025-10-31
Specialties
Licenses
- License MA
- 10004072
Location
- Practice location
- 255 WOODLAND WAY
- City
- RUSSELL MA
- Postal code
- 010719655
- Phone
- 413-486-0808
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.