Healthcare Provider Details

I. General information

NPI: 1114152352
Provider Name (Legal Business Name): ANNE C. PRATT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 ALLEN ST FAMILY CARE MEDICAL CENTER
SPRINGFIELD MA
01118-1803
US

IV. Provider business mailing address

1515 ALLEN ST FAMILY CARE MEDICAL CENTER
SPRINGFIELD MA
01118-1803
US

V. Phone/Fax

Practice location:
  • Phone: 413-783-9114
  • Fax: 413-341-3286
Mailing address:
  • Phone: 413-783-9114
  • Fax: 413-341-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4158
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number4158
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: