Odonata Psychotherapy & Retreat Center LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

ODONATA PSYCHOTHERAPY & RETREAT CENTER LLC

Practice address

121 Main St
Buzzards Bay, MA 02532

Phone

(774) 247-4939

NPI assigned

Mar 11, 2014

Last updated

Aug 15, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nancy C Wiley

Title

Owner

Phone

(774) 247-4939

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amanda Baird, LADC-1, LICSW

  • Clinical Social Worker
  • South Dennis, MA
  • NPI 1538671904
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534291200000",
    "number": "1689090862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 PINE RD",
            "city": "FORESTDALE",
            "state": "MA",
            "postal_code": "026441413",
            "telephone_number": "774-247-4939",
            "fax_number": "774-302-4419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 MAIN ST",
            "city": "BUZZARDS BAY",
            "state": "MA",
            "postal_code": "02532",
            "telephone_number": "774-247-4939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODONATA PSYCHOTHERAPY & RETREAT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2018-08-15",
        "status": "A",
        "authorized_official_last_name": "WILEY",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "774-247-4939"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110101319A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mobile OT LLC
• Matthew Moeller, PMHNP
• New Day Behavioral Health PLLC
• Daniel Noe, IDC
• Lawrence E O'Brien
• Odonata Psychotherapy & Retreat Center LLC
• Cathleen Odonnell, DVM
• Barbara Crystal Olson, M.D.
• Amy Beth Pacheco, BA
• Halley M Palmer, LICSW

• Mental Health Counselor in Buzzards Bay, MA
• Providers in Buzzards Bay, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.