MEDICARE: AMESBURY PSYCHOLOGICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437112927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMESBURY PSYCHOLOGICAL CENTER, INC

Provider Business Mailing Address
First Line	:	24 MORRILL PL
Second Line	:
City	:	AMESBURY
State	:	MA
Zip	:	01913-3530
Country	:	US
Telephone Number	:	978-388-5700
Fax Number	:	978-388-4052

Provider Business Practice Location Address
First Line	:	24 MORRILL PLACE
Second Line	:
City	:	AMESBURY
State	:	MA
Zip	:	01913-3530
Country	:	US
Telephone Number	:	978-388-5700
Fax Number	:	978-388-4052

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN NESTOR
Credential	:	PHD, LMHC, LMFT
Telephone Number	:	978-388-5700

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	06/23/2010

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