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General NPI Number Information
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NPI Number | 1306912415
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Entity Type | Individual
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Provider Name | JULIE M MACK PHD PSYCHOLOGY
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 09/29/2011
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Provider Practice Location Address
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Address Line | 24 ROCKLAND ST UNIT 7 HANOVER PSYCHOLOGICAL ASSOCIATES
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City | HANOVER
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State | MA
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Zip | 02339-2226
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Country | US
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Telephone | 781-826-8228
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Fax | 781-826-0965
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Provider Business Mailing Address
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Address Line | 24 ROCKLAND ST UNIT 7 HANOVER PSYCHOLOGICAL ASSOCIATES
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City | HANOVER
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State | MA
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Zip | 02339-2226
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Country | US
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Telephone | 781-826-8228
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Fax | 781-826-0965
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 3769
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3679
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 3769
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | B769
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License Number State | MA
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