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General NPI Number Information
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NPI Number | 1851814917
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Entity Type | Organization
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Legal Business Name | PAX ET BONUM PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 07/20/2017
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Last Update Date | 07/20/2017
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Provider Practice Location Address
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Address Line | 10 CONCORD AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02138-2322
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Country | US
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Telephone | 617-515-9902
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Fax |
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Provider Business Mailing Address
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Address Line | 93 OXFORD ST # 2
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City | ARLINGTON
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State | MA
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Zip | 02474-6907
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Country | US
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Telephone | 617-515-9902
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/SOLE MEMBER
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Name | DR. KRISTEN K ELLARD
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Credential | PH.D.
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Telephone | 617-515-9902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 10310
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License Number State | MA
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