Provider Demographics
NPI:1073268629
Name:AXELRAD PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:AXELRAD PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:AXELRAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:413-225-1943
Mailing Address - Street 1:194 MONTAGUE RD
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:194 MONTAGUE RD
Practice Address - Street 2:
Practice Address - City:LEVERETT
Practice Address - State:MA
Practice Address - Zip Code:01054-9727
Practice Address - Country:US
Practice Address - Phone:413-225-1943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty