Healthcare Provider Details

I. General information

NPI: 1801879101
Provider Name (Legal Business Name): JAMES MEHEGAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 ALDRIN RD
PLYMOUTH MA
02360-4804
US

IV. Provider business mailing address

1 STANDISH RD
DUXBURY MA
02332-5104
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-0665
  • Fax:
Mailing address:
  • Phone: 781-934-9861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4223
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: