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General NPI Number Information
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NPI Number | 1912013970
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Entity Type | Individual
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Provider Name | MARCIA LEA GALVINHILL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 148 WORCESTER ST
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City | WEST BOYLSTON
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State | MA
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Zip | 01583-1751
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Country | US
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Telephone | 508-353-9157
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Fax |
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Provider Business Mailing Address
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Address Line | 12 WATSON LN
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City | RUTLAND
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State | MA
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Zip | 01543-1346
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Country | US
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Telephone | 774-234-0125
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 6048
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License Number State | OH
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