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Clinical Neuropsychologist

Peabody, Massachusetts

Provider NPI: 1053340612

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
Tel: 978-354-2730  Fax: --

Business Mailing Address:
Tel: 978-354-2730  Fax: --

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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