1740616556 NPI number — THINK-DIFF INSTITUTE

Table of content: (NPI 1740616556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740616556 NPI number — THINK-DIFF INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THINK-DIFF INSTITUTE
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:
1740616556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 WATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURYPORT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01950-3144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-726-3444
Provider Business Mailing Address Fax Number:
978-477-0312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1666 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
SUITE F1
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02420-5317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-726-3444
Provider Business Practice Location Address Fax Number:
978-477-0312
Provider Enumeration Date:
09/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MACLEAN-HOOVER
Authorized Official First Name:
PANDORA
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
978-726-3444

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  110705 , 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: P22747 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com