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General NPI Number Information
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NPI Number | 1154569317
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Entity Type | Organization
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Legal Business Name | LIFE HEALTH CENTER
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 348 LUNENBURG ST # MA #301
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City | FITCHBURG
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State | MA
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Zip | 01420-4566
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Country | US
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Telephone | 978-345-0953
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Fax | 978-345-0585
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Provider Business Mailing Address
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Address Line | 348 LUNENBURG MA #301
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City | FITCHBURG
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State | MA
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Zip | 01420
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Country | US
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Telephone | 978-345-0953
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Fax | 978-345-0585
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROLAND H UNGERER
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Credential | M.D.
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Telephone | 978-345-0953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 33670
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License Number State | MA
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