Provider Demographics
NPI:1093330854
Name:WORCESTER COUNSELING COLLECTIVE LLC
Entity Type:Organization
Organization Name:WORCESTER COUNSELING COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:BETHANY
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-493-9084
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-0023
Mailing Address - Country:US
Mailing Address - Phone:508-493-9084
Mailing Address - Fax:
Practice Address - Street 1:22 WEST ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527-2676
Practice Address - Country:US
Practice Address - Phone:508-389-3138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty