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General NPI Number Information
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NPI Number | 1073674420
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Entity Type | Organization
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Legal Business Name | CHOATE HEALTH MANAGEMENT
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 391 VARNUM AVE
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City | LOWELL
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State | MA
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Zip | 01854-2119
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Country | US
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Telephone | 978-322-5120
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Fax |
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Provider Business Mailing Address
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Address Line | 391 VARNUM AVE
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City | LOWELL
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State | MA
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Zip | 01854-2119
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Country | US
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Telephone | 978-322-5120
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. CAROL A. PORDER
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Credential | M.A.
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Telephone | 978-322-5120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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