Organization
ICSOLUTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIAYNE LUPERON LADC-1, MFT, MA (CEO/CLINICIAN)
(617) 785-8127
Entity
Organization
Contact information
Practice address
20 STRATHMORE RD, WORCESTER, MA 01610-3414
(617) 785-8127
Mailing address
191 E QUASSET RD, WOODSTOCK, CT 06281-3307
(617) 785-8127
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
01/13/2022
Last updated
05/20/2024
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