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General NPI Number Information
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NPI Number | 1942401427
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Entity Type | Organization
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Legal Business Name | BEDFORD PSYCHOLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 110 GREAT RD
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City | BEDFORD
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State | MA
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Zip | 01730-2729
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Country | US
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Telephone | 781-275-7555
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Fax | 781-275-7555
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Provider Business Mailing Address
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Address Line | 110 GREAT RD
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City | BEDFORD
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State | MA
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Zip | 01730-2729
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Country | US
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Telephone | 781-275-7555
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Fax | 781-275-7555
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. WILLIAM D GAMMON
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Credential | PH.D.
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Telephone | 781-275-7555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2402
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License Number State | MA
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