Healthcare Provider Details

I. General information

NPI: 1215047428
Provider Name (Legal Business Name): SIGMUND HOUGH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CENTER, SUITE 207-P
BEVERLY MA
01915-6144
US

IV. Provider business mailing address

3 BESSON STREET PMB 239
MARBLEHEAD MA
01945
US

V. Phone/Fax

Practice location:
  • Phone: 617-834-3724
  • Fax:
Mailing address:
  • Phone: 617-834-3724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number4608
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4608
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number4608
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number4608
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: