Provider Demographics
NPI:1700810025
Name:GENERAL PSYCHOLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:GENERAL PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-475-3590
Mailing Address - Street 1:3 DUNDEE PARK DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3723
Mailing Address - Country:US
Mailing Address - Phone:978-475-3590
Mailing Address - Fax:
Practice Address - Street 1:3 DUNDEE PARK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3723
Practice Address - Country:US
Practice Address - Phone:978-475-3590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA320103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10069Medicare ID - Type Unspecified