Healthcare Provider Details

I. General information

NPI: 1376380006
Provider Name (Legal Business Name): RESTORE PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 ST CLAIR RD
BRIMFIELD MA
01010-2120
US

IV. Provider business mailing address

12 ST CLAIR RD
BRIMFIELD MA
01010-2120
US

V. Phone/Fax

Practice location:
  • Phone: 413-245-1487
  • Fax: 413-895-6589
Mailing address:
  • Phone: 413-245-1487
  • Fax: 413-895-6589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. TINA RENEE ADAMS
Title or Position: OWNER
Credential: PH.D.
Phone: 413-245-1487