=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659506228
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRANBERRY COUNSELING PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2009
-----------------------------------------------------
Last Update Date | 02/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 WINTER ST STE 303
-----------------------------------------------------
City | WEYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02188-3336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-837-5344
-----------------------------------------------------
Fax | 781-803-2728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 WINTER ST STE 303
-----------------------------------------------------
City | WEYMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02188-3336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-837-5344
-----------------------------------------------------
Fax | 781-803-2728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TERRY ALAN HAYES
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 781-837-5344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 3821
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------