MEDICARE: ENDEAVOR PSYCHOLOGY AND CONSULTING LLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1750917506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDEAVOR PSYCHOLOGY AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	71 WALKER RD
Second Line	:
City	:	SWAMPSCOTT
State	:	MA
Zip	:	01907-2054
Country	:	US
Telephone Number	:	617-817-8513
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 SPRING ST
Second Line	:
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945-3314
Country	:	US
Telephone Number	:	617-207-4124
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRAD SPICKARD
Credential	:	PHD
Telephone Number	:	617-207-4124

Provider Enumeration Date	:	03/12/2020
Last Update Date	:	03/12/2020

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Directions to “ENDEAVOR PSYCHOLOGY AND CONSULTING LLC ” Practice Location

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