Healthcare Provider Details

I. General information

NPI: 1740807528
Provider Name (Legal Business Name): CENTI PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 RENWICK RD
MELROSE MA
02176-1218
US

IV. Provider business mailing address

35 RENWICK RD
MELROSE MA
02176-1218
US

V. Phone/Fax

Practice location:
  • Phone: 617-863-0090
  • Fax: 781-876-0002
Mailing address:
  • Phone: 617-863-0090
  • Fax: 781-876-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN CENTI
Title or Position: NEUROPSYCHOLOGIST/OWNER
Credential: PHD
Phone: 617-863-0090