Provider Demographics
NPI:1124356233
Name:VERMILYEA, JAMES A (PH D, MBA)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:VERMILYEA
Suffix:
Gender:M
Credentials:PH D, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TRADECENTER
Mailing Address - Street 2:SUITE 7790
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1883
Mailing Address - Country:US
Mailing Address - Phone:339-224-7695
Mailing Address - Fax:781-281-0644
Practice Address - Street 1:300 TRADECENTER
Practice Address - Street 2:SUITE 7790
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1883
Practice Address - Country:US
Practice Address - Phone:339-224-7695
Practice Address - Fax:781-281-0644
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4233103TB0200X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling