=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144281379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGIE M TRZEPACZ PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 WEST STREET
-----------------------------------------------------
City | WALPOLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-660-1510
-----------------------------------------------------
Fax | 508-660-3122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44A W WALNUT ST
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01757
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-478-4577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 8291
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------