Provider Demographics
NPI:1992850663
Name:PSYCHIATRY AND FAMILY COUNSELING OF WORCESTER COUNTY, LLP
Entity Type:Organization
Organization Name:PSYCHIATRY AND FAMILY COUNSELING OF WORCESTER COUNTY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-752-5191
Mailing Address - Street 1:52 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2134
Mailing Address - Country:US
Mailing Address - Phone:508-752-5191
Mailing Address - Fax:508-792-1514
Practice Address - Street 1:52 CEDAR ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2134
Practice Address - Country:US
Practice Address - Phone:508-752-5191
Practice Address - Fax:508-792-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16163 W10305OtherBCBS OF MA
MA1004790OtherFALLON HEALTHCARE
MA612881OtherTUFTS HEALTH PLAN
MA056724000OtherMAGELLAN BEHAVIORAL HEALT
MA44047OtherCIGNA
MAM21771Medicare ID - Type Unspecified