Healthcare Provider Details

I. General information

NPI: 1922876135
Provider Name (Legal Business Name): HIGHLANDS PERFORMANCE AND PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 CHURCH ST UNIT 2
WALTHAM MA
02452-5618
US

IV. Provider business mailing address

132 CHURCH ST UNIT 2
WALTHAM MA
02452-5618
US

V. Phone/Fax

Practice location:
  • Phone: 401-862-8803
  • Fax:
Mailing address:
  • Phone: 401-862-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TREVOR COTE
Title or Position: OWNER, PSYCHOLOGIST
Credential: PHD
Phone: 401-862-8803