Healthcare Provider Details

I. General information

NPI: 1992025506
Provider Name (Legal Business Name): ASCENDANT PSYCHIATRIC & CONSULTING CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 DERBY ST STE 21-22
HINGHAM MA
02043-4007
US

IV. Provider business mailing address

175 DERBY ST STE 21-22
HINGHAM MA
02043-4007
US

V. Phone/Fax

Practice location:
  • Phone: 781-556-5662
  • Fax: 781-836-0676
Mailing address:
  • Phone: 781-556-5662
  • Fax: 781-836-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6175
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6175
License Number StateMA

VIII. Authorized Official

Name: DR. LINDA M CARMODY-KACZOR
Title or Position: CEO
Credential: PHD
Phone: 781-556-5662