1598770984 NPI number — PSYCH CARE ASSOC PC

Table of content: (NPI 1598770984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598770984 NPI number — PSYCH CARE ASSOC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCH CARE ASSOC PC
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:
Provider Other Organization Name Type Code:
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:
1598770984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 POST OFFICE PARK STE 8501-B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILBRAHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01095-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-583-6750
Provider Business Mailing Address Fax Number:
833-974-2219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 POST OFFICE PARK STE 8501-B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILBRAHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01095-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-583-6750
Provider Business Practice Location Address Fax Number:
833-974-2219
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QAYYUM
Authorized Official First Name:
ASIMAH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
413-583-6750

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3024750 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: BCBS OF MA . This is a "M19012" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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