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General NPI Number Information
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NPI Number | 1407330509
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Entity Type | Organization
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Legal Business Name | COASTAL PSYCHOLOGICAL CENTER, LLC.
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 36 WOBURN ST STE 6
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City | READING
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State | MA
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Zip | 01867-2903
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Country | US
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Telephone | 978-276-9622
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Fax |
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Provider Business Mailing Address
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Address Line | 36 WOBURN ST STE 6
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City | READING
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State | MA
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Zip | 01867-2903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | DR. KELLEY KNOCH-KABARWAL
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Credential |
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Telephone | 978-276-9622
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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 |
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License Number State |
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