Healthcare Provider Details

I. General information

NPI: 1740405083
Provider Name (Legal Business Name): ANN CONDON PSYCHOTHERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3937 MAIN ST
BREWSTER MA
02631-1592
US

IV. Provider business mailing address

3937 MAIN ST
BREWSTER MA
02631-1592
US

V. Phone/Fax

Practice location:
  • Phone: 508-240-0092
  • Fax: 508-255-1311
Mailing address:
  • Phone: 508-240-0092
  • Fax: 508-255-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4767
License Number StateMA

VIII. Authorized Official

Name: MRS. ANN PATRICIA CONDON
Title or Position: PSYCHOTHERAPIST
Credential: MA,LMHC
Phone: 508-240-0092