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General NPI Number Information
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NPI Number | 1467949636
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Entity Type | Organization
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Legal Business Name | GLMPSYCHOLOGY LLC
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 185 DEVONSHIRE ST STE 503
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City | BOSTON
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State | MA
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Zip | 02110-1415
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Country | US
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Telephone | 617-841-7272
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Fax |
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Provider Business Mailing Address
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Address Line | 185 DEVONSHIRE ST STE 503
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City | BOSTON
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State | MA
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Zip | 02110-1415
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Country | US
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Telephone | 617-841-7272
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TOMASZ VAV
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Credential |
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Telephone | 617-435-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 10337
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License Number State | MA
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