=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316041650
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COVE COUNSELLING ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2006
-----------------------------------------------------
Last Update Date | 08/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 LONG POND ROAD STE 210
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-746-8004
-----------------------------------------------------
Fax | 508-746-8099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 LONG POND ROAD STE 210
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-746-8004
-----------------------------------------------------
Fax | 508-746-8099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN R OBRIEN
-----------------------------------------------------
Credential | ED D
-----------------------------------------------------
Telephone | 508-746-8004
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------