Organization
MEDITELECARE OF MASSACHUSETTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA GODFREY (CREDENTIALING & ENROLLMENT MANAGER)
(860) 398-6441
Entity
Organization
Contact information
Practice address
84 STATE ST, BOSTON, MA 02109-2202
(860) 788-6404
(860) 829-0495
Mailing address
PO BOX 1595, MIDDLETOWN, CT 06457-8095
(860) 788-6404
(860) 829-0495
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
04/09/2021
Last updated
05/05/2025
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