Healthcare Provider Details

I. General information

NPI: 1972536563
Provider Name (Legal Business Name): PETER JAMES ERINES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 FOUNTAIN ST STE 402
FRAMINGHAM MA
01702-6280
US

IV. Provider business mailing address

63 FOUNTAIN ST STE 402
FRAMINGHAM MA
01702-6280
US

V. Phone/Fax

Practice location:
  • Phone: 508-872-4813
  • Fax: 508-626-0454
Mailing address:
  • Phone: 508-872-4813
  • Fax: 508-626-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4709
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: