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General NPI Number Information
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NPI Number | 1043703598
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Entity Type | Individual
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Provider Name | PAUL ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 06/10/2018
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Last Update Date | 06/10/2018
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Provider Practice Location Address
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Address Line | 42 PATTON RD
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City | DEVENS
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State | MA
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Zip | 01434-3802
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Country | US
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Telephone | 978-796-1420
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Fax |
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Provider Business Mailing Address
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Address Line | 22 ROSEMERE RD
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City | CUMBERLAND
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State | RI
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Zip | 02864-3409
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Country | US
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Telephone | 978-796-1420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 7308
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License Number State | MA
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