Healthcare Provider Details

I. General information

NPI: 1184818924
Provider Name (Legal Business Name): HOPE PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CLARKE ST SUITE 21
LEXINGTON MA
02421-4988
US

IV. Provider business mailing address

16 CLARKE ST SUITE 21
LEXINGTON MA
02421-4988
US

V. Phone/Fax

Practice location:
  • Phone: 781-402-2442
  • Fax: 781-402-1744
Mailing address:
  • Phone: 781-402-2442
  • Fax: 781-402-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES J. SLAGEN
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 781-402-2442