Healthcare Provider Details

I. General information

NPI: 1952850463
Provider Name (Legal Business Name): R. BUIVYDAS, PHD, LMHC, COUPLES COUNSELING & INDIVIDUAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 E MAIN ST
MARLBOROUGH MA
01752-5421
US

IV. Provider business mailing address

297 E MAIN ST
MARLBOROUGH MA
01752-5421
US

V. Phone/Fax

Practice location:
  • Phone: 508-281-0222
  • Fax:
Mailing address:
  • Phone: 508-281-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4099
License Number StateMA

VIII. Authorized Official

Name: DR. ROMAS D. BUIVYDAS
Title or Position: PSYCHOTHERAPIST
Credential: PHD, LMHC
Phone: 508-281-0222