Healthcare Provider Details

I. General information

NPI: 1083290936
Provider Name (Legal Business Name): NORTH SHORE ASSESSMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/22/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 REAR MAIN STREET
WENHAM MA
01944
US

IV. Provider business mailing address

152 REAR MAIN STREET
WENHAM MA
01944
US

V. Phone/Fax

Practice location:
  • Phone: 978-233-1322
  • Fax: 978-560-1234
Mailing address:
  • Phone: 978-233-1322
  • Fax: 978-560-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1336398619
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerNPI

VIII. Authorized Official

Name: HARVEY KENT WILSON
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 978-233-1322