Healthcare Provider Details

I. General information

NPI: 1730132382
Provider Name (Legal Business Name): HAL FALES PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FEDERAL ST C/O SERVICENETINC
GREENFIELD MA
01301-2546
US

IV. Provider business mailing address

73 AUDUBON RD
LEEDS MA
01053-9726
US

V. Phone/Fax

Practice location:
  • Phone: 413-775-4717
  • Fax: 413-772-3724
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6941
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: