Healthcare Provider Details

I. General information

NPI: 1972243871
Provider Name (Legal Business Name): AJW PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SOUTH AVE 2ND FLOOR
NATICK MA
01760
US

IV. Provider business mailing address

841 WORCESTER ST STE E-341
NATICK MA
01760-2016
US

V. Phone/Fax

Practice location:
  • Phone: 617-356-8054
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. AISHWARYA JHA WEAVER
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D
Phone: 617-356-8054