Healthcare Provider Details

I. General information

NPI: 1912949835
Provider Name (Legal Business Name): GLENN ROBIN KESSLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAIN ST
NORTHBORO MA
01532-1942
US

IV. Provider business mailing address

20 MAIN ST
NORTHBORO MA
01532-1942
US

V. Phone/Fax

Practice location:
  • Phone: 508-393-9899
  • Fax: 508-393-9480
Mailing address:
  • Phone: 508-393-9899
  • Fax: 508-393-9480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3661
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: