Healthcare Provider Details

I. General information

NPI: 1053589853
Provider Name (Legal Business Name): ASSOCIATION OF INDEPENDENT PSYCHOLOGISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 MAIN ST SUITE 1049
WORCESTER MA
01608-2583
US

IV. Provider business mailing address

390 MAIN ST SUITE 1049
WORCESTER MA
01608-2583
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-8100
  • Fax: 508-792-4026
Mailing address:
  • Phone: 508-753-8100
  • Fax: 508-792-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5473
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1087
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6044
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number34943
License Number StateMA

VIII. Authorized Official

Name: MR. RICHARD B. ABELLI
Title or Position: MANAGING PRACTICIONER
Credential: LMHC
Phone: 508-341-3379