Healthcare Provider Details

I. General information

NPI: 1649319468
Provider Name (Legal Business Name): GORDON B PARKER ED.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 WILDER HILL RD
SHELBURNE FALLS MA
01370-9429
US

IV. Provider business mailing address

151 WILDER HILL RD
SHELBURNE FALLS MA
01370-9429
US

V. Phone/Fax

Practice location:
  • Phone: 413-625-2707
  • Fax: 413-648-5450
Mailing address:
  • Phone: 413-625-2707
  • Fax: 413-648-5450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3873
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: