1487708632 NPI number — PSYCHOLOGICAL CONSULTING, P.C.

Table of content: (NPI 1487708632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487708632 NPI number — PSYCHOLOGICAL CONSULTING, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHOLOGICAL CONSULTING, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARIE LISE ROYER, PH.D.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487708632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1860
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAKEFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01880-5860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-224-2820
Provider Business Mailing Address Fax Number:
781-224-0074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 CEDAR ST
Provider Second Line Business Practice Location Address:
SUITE 58
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801-7246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-224-2820
Provider Business Practice Location Address Fax Number:
781-224-0074
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROYER
Authorized Official First Name:
MARIE LISE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
781-224-2820

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  4876 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001859 . This is a "HPHC-PACIFICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 135081 . This is a "VALUEOPTIONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5098732 . This is a "AETNA BEH. HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 790711 . This is a "TUFTS HEALTH PLAN MEDICARE PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W05512 . This is a "BC/BS OF MA FOR 'MARIE LISE ROYER'" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W10505 . This is a "EMPIRE BCBS, EIN#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 102931 . This is a "MBH-MAGELLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1899112 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 790711 . This is a "TUFTS-NAVIGATOR,MYNAME&SS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 790711 . This is a "TUFTS HEALTH PLANS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: W10505 . This is a "BC/BS OF MA FOR 'PSYCHOLOGICAL CONSULTING, P.C.'" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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