Healthcare Provider Details

I. General information

NPI: 1225045198
Provider Name (Legal Business Name): DON P SUGAI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E MERRIMACK ST STE 23
LOWELL MA
01852-1900
US

IV. Provider business mailing address

77 E MERRIMACK ST STE 23
LOWELL MA
01852-1900
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-3711
  • Fax:
Mailing address:
  • Phone: 978-452-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2626
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: