Healthcare Provider Details

I. General information

NPI: 1871678136
Provider Name (Legal Business Name): JOHN H ANDERSON JR. ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 CONWAY ST
GREENFIELD MA
01301-1521
US

IV. Provider business mailing address

329 CONWAY ST
GREENFIELD MA
01301-1521
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-6301
  • Fax: 866-644-0871
Mailing address:
  • Phone: 413-774-6301
  • Fax: 866-644-0871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2851
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2851
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: