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General NPI Number Information
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NPI Number | 1215611173
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICINE AND PSYCHOTHERAPY
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 195 WHITING ST STE 2B
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City | HINGHAM
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State | MA
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Zip | 02043-3717
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Country | US
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Telephone | 781-799-0895
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Fax |
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Provider Business Mailing Address
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Address Line | 2506 HOCKLEY DR
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City | HINGHAM
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State | MA
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Zip | 02043-1558
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Country | US
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Telephone | 781-799-0895
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE DIRECTOR
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Name | PATRICK GORMAN
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Credential | LICSW
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Telephone | 781-799-0895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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