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General NPI Number Information
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NPI Number | 1932172632
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Entity Type | Organization
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Legal Business Name | LIFEDIMENSIONS NEUROPSYCHOLOGICAL SERVICES, INC
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Dates
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Enumeration Date | 02/12/2006
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Last Update Date | 03/19/2011
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Provider Practice Location Address
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Address Line | 250 POND ST LIFEDIMENSIONS NEUROPSYCHOLOGICAL SERVICES, INC.
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City | BRAINTREE
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State | MA
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Zip | 02184-5351
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Country | US
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Telephone | 781-348-2258
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Fax | 781-348-2132
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Provider Business Mailing Address
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Address Line | 250 POND ST LIFEDIMENSIONS NEUROPSYCHOLOGICAL SERVICES, INC.
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City | BRAINTREE
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State | MA
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Zip | 02184-5351
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Country | US
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Telephone | 781-348-2258
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Fax | 781-348-2132
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Authorized Official
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Title or Position | CLERK, CO-OWNER
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Name | DR. MARIE M WALBRIDGE
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Credential | PH.D.
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Telephone | 781-348-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 4712
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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