Healthcare Provider Details

I. General information

NPI: 1760607717
Provider Name (Legal Business Name): DAVID C. ADAMS ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 MASSACHUSETTS AVE SUITE 101
CAMBRIDGE MA
02140-1646
US

IV. Provider business mailing address

89 LOWELL AVE #B
NEWTONVILLE MA
02460-1502
US

V. Phone/Fax

Practice location:
  • Phone: 617-964-3525
  • Fax: 617-547-0904
Mailing address:
  • Phone: 617-964-3525
  • Fax: 617-547-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6518
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: