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General NPI Number Information
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NPI Number | 1750419255
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Entity Type | Organization
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Legal Business Name | FIREPSYCH, INC.
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 470 WASHINGTON ST STE 22
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City | NORWOOD
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State | MA
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Zip | 02062-2343
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Country | US
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Telephone | 781-762-8815
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Fax |
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Provider Business Mailing Address
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Address Line | 470 WASHINGTON ST STE 22
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City | NORWOOD
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State | MA
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Zip | 02062-2343
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Country | US
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Telephone | 781-762-8815
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT STADOLNIK
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Credential | ED.D.
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Telephone | 781-762-8815
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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 | 6574
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License Number State | MA
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