Healthcare Provider Details

I. General information

NPI: 1750749149
Provider Name (Legal Business Name): LEADERSHIP PSYCHOLOGY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 MAIN ST SUITE #319
CONCORD MA
01742-3302
US

IV. Provider business mailing address

102 SOUTH RD
PEPPERELL MA
01463-1257
US

V. Phone/Fax

Practice location:
  • Phone: 978-393-1925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number9751
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number9751
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number9751
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9751
License Number StateMA

VIII. Authorized Official

Name: DR. MICHAEL CASSELLA
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 978-393-1925