Provider Demographics
NPI:1124191861
Name:PSYCHSERVICES, PC
Entity Type:Organization
Organization Name:PSYCHSERVICES, PC
Other - Org Name:LEONARD MORSE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-647-0222
Mailing Address - Street 1:67 UNION ST
Mailing Address - Street 2:SUITE #205
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-647-0222
Mailing Address - Fax:508-647-0333
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:SUITE #205
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-647-0222
Practice Address - Fax:508-647-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7600383OtherTUFTS HEALTH PLAN
MAM13645OtherBLUE CROSS BLUE SHIELD MA
MAM 13645Medicare PIN