Provider Demographics
NPI:1518137140
Name:INTELLIGENCE LIMITED INC
Entity type:Organization
Organization Name:INTELLIGENCE LIMITED INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:508-240-0092
Mailing Address - Street 1:3937 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-1592
Mailing Address - Country:US
Mailing Address - Phone:508-240-0092
Mailing Address - Fax:508-255-1311
Practice Address - Street 1:3937 MAIN ST
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-1592
Practice Address - Country:US
Practice Address - Phone:508-240-0092
Practice Address - Fax:508-255-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891464Medicaid
MA1891464Medicaid