Provider Demographics
NPI:1134578719
Name:COUNSELING & ASSESSMENT CLINIC OF WORCESTER, LLC
Entity type:Organization
Organization Name:COUNSELING & ASSESSMENT CLINIC OF WORCESTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HYLTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:508-756-5400
Mailing Address - Street 1:38 FRONT ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1732
Mailing Address - Country:US
Mailing Address - Phone:508-756-5499
Mailing Address - Fax:508-756-5433
Practice Address - Street 1:255 PARK AVE STE 412
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1989
Practice Address - Country:US
Practice Address - Phone:508-756-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4CKZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1894196Medicaid
MA1894196Medicaid