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General NPI Number Information
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NPI Number | 1073843249
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Entity Type | Organization
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Legal Business Name | HALLOWELL CENTER
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 75 2ND AVE SUITE 310
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City | NEEDHAM
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State | MA
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Zip | 02494-2820
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Country | US
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Telephone | 781-726-6698
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Fax | 781-726-6725
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Provider Business Mailing Address
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Address Line | 75 2ND AVE SUITE 310
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City | NEEDHAM
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State | MA
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Zip | 02494-2820
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Country | US
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Telephone | 781-726-6698
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Fax |
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Authorized Official
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Title or Position | C.E.O
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Name | DR. THOR BERGERSEN
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Credential | M.D.
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Telephone | 781-726-6698
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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 | 7963
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License Number State | MA
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