1932172632 NPI number — LIFEDIMENSIONS NEUROPSYCHOLOGICAL SERVICES, INC

Table of content: (NPI 1932172632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932172632 NPI number — LIFEDIMENSIONS NEUROPSYCHOLOGICAL SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEDIMENSIONS NEUROPSYCHOLOGICAL SERVICES, INC
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:
6
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:
1932172632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 POND ST
Provider Second Line Business Mailing Address:
LIFEDIMENSIONS NEUROPSYCHOLOGICAL SERVICES, INC.
Provider Business Mailing Address City Name:
BRAINTREE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02184-5351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-348-2258
Provider Business Mailing Address Fax Number:
781-348-2132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 POND ST
Provider Second Line Business Practice Location Address:
LIFEDIMENSIONS NEUROPSYCHOLOGICAL SERVICES, INC.
Provider Business Practice Location Address City Name:
BRAINTREE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02184-5351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-348-2258
Provider Business Practice Location Address Fax Number:
781-348-2132
Provider Enumeration Date:
02/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALBRIDGE
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CLERK, CO-OWNER
Authorized Official Telephone Number:
781-348-3900

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  4712 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9721771 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W10469 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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