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General NPI Number Information
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NPI Number | 1003711078
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Entity Type | Organization
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Legal Business Name | NORTHERN NEUROPSYCHOLOGY, LLC
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Dates
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Enumeration Date | 10/10/2026
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Last Update Date | 10/10/2026
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Provider Practice Location Address
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Address Line | 540 MAIN ST STE 17A
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City | WINCHESTER
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State | MA
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Zip | 01890-2940
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Country | US
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Telephone | 781-710-6105
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Fax | 617-231-9581
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Provider Business Mailing Address
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Address Line | 540 MAIN ST STE 17A
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City | WINCHESTER
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State | MA
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Zip | 01890-2940
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Country | US
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Telephone | 781-710-6105
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Fax | 617-231-9581
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | DR. NICOLE KASSISSIEH
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Credential | PSYD
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Telephone | 781-710-6105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State | NULL
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