1205211414 NPI number — PERCEPTIONS PSYCHOTHHERAPY

Table of content: (NPI 1205211414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205211414 NPI number — PERCEPTIONS PSYCHOTHHERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERCEPTIONS PSYCHOTHHERAPY
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:
1205211414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 SUMMER ST
Provider Second Line Business Mailing Address:
SUITE 335
Provider Business Mailing Address City Name:
FITCHBURG
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01420-5783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-696-5524
Provider Business Mailing Address Fax Number:
978-696-5534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76 SUMMER ST
Provider Second Line Business Practice Location Address:
SUITE 335
Provider Business Practice Location Address City Name:
FITCHBURG
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01420-5783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-696-5524
Provider Business Practice Location Address Fax Number:
978-696-5534
Provider Enumeration Date:
07/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WOODGETT
Authorized Official First Name:
SILVIA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
CLINICIAN OR COUNSELOR
Authorized Official Telephone Number:
978-652-8590

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  101YA0400X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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