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General NPI Number Information
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NPI Number | 1871240051
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Entity Type | Organization
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Legal Business Name | RE-ANCHORED THERAPY
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 8 WALNUT ST
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City | QUINCY
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State | MA
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Zip | 02171-1700
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Country | US
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Telephone | 774-826-7528
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Fax |
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Provider Business Mailing Address
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Address Line | 377 WILLARD ST # 302
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City | QUINCY
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State | MA
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Zip | 02169-6122
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Country | US
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Telephone | 774-826-7528
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. ASHLEY C SULTAN
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Credential | PHD
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Telephone | 617-657-4125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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