Provider Demographics
NPI:1073843249
Name:HALLOWELL CENTER
Entity Type:Organization
Organization Name:HALLOWELL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:THOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-726-6698
Mailing Address - Street 1:75 2ND AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2820
Mailing Address - Country:US
Mailing Address - Phone:781-726-6698
Mailing Address - Fax:
Practice Address - Street 1:75 2ND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2820
Practice Address - Country:US
Practice Address - Phone:781-726-6698
Practice Address - Fax:781-726-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7963103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty