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General NPI Number Information
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NPI Number | 1811939473
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Entity Type | Organization
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Legal Business Name | CENTERS FOR AGING AND MEMORY
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 431 LAKE ST
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City | SHREWSBURY
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State | MA
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Zip | 01545-3972
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Country | US
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Telephone | 508-259-7684
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7077
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City | WORCESTER
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State | MA
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Zip | 01605-0077
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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 | CLINICAL PSYCHOLOGIST
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Name | DR. ELIZABETH H NASSER
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Credential | PH.D.
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Telephone | 508-259-7684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8127-PR
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License Number State | MA
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