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General NPI Number Information
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NPI Number | 1114339264
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Entity Type | Organization
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Legal Business Name | PORT PSYCHOLOGY INC
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Dates
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Enumeration Date | 05/23/2014
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Last Update Date | 05/23/2014
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Provider Practice Location Address
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Address Line | 3 MARKET ST
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City | NEWBURYPORT
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State | MA
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Zip | 01950-2586
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Country | US
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Telephone | 978-462-3033
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Fax | 978-462-1999
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Provider Business Mailing Address
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Address Line | 3 MARKET ST
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City | NEWBURYPORT
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State | MA
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Zip | 01950-2586
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Country | US
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Telephone | 978-462-3033
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Fax | 978-462-1999
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MELVIN NAGLER
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Credential | PH.D.
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Telephone | 978-462-3033
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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 | 2286
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License Number State | MA
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