Provider Demographics
NPI:1114086741
Name:AUDIOLOGY ASSOC OF WORCESTER
Entity Type:Organization
Organization Name:AUDIOLOGY ASSOC OF WORCESTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD FAAA
Authorized Official - Phone:508-792-9293
Mailing Address - Street 1:130 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2430
Mailing Address - Country:US
Mailing Address - Phone:508-792-9293
Mailing Address - Fax:508-798-7989
Practice Address - Street 1:130 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2430
Practice Address - Country:US
Practice Address - Phone:508-792-9293
Practice Address - Fax:508-798-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
Not Answered231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1531468Medicaid
MAAD0041OtherBC BS
MAAD0041OtherBC BS