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General NPI Number Information
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NPI Number | 1073282596
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Entity Type | Organization
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Legal Business Name | BAYSTATE PEDIATRIC NEUROPSYCHOLOGY SERVICES, LLC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 352 PARK ST STE 208
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City | NORTH READING
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State | MA
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Zip | 01864-2158
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Country | US
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Telephone | 978-276-4041
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Fax | 978-207-1007
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Provider Business Mailing Address
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Address Line | 352 PARK ST STE 208
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City | NORTH READING
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State | MA
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Zip | 01864-2158
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Country | US
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Telephone | 978-276-4041
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Fax | 978-207-1007
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Authorized Official
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Title or Position | OWNER, LICENSED PSYCHOLOGIST
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Name | DR. KAREN E KILEY-BRABECK
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Credential | PHD
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Telephone | 978-276-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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