Provider Demographics
NPI:1134285109
Name:GEORGE, JOYCE LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:LYNN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOYCE
Other - Middle Name:KOURY
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:340 MAIN ST
Mailing Address - Street 2:SUITE 807
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:598-795-1644
Mailing Address - Fax:
Practice Address - Street 1:340 MAIN ST
Practice Address - Street 2:SUITE 807
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1604
Practice Address - Country:US
Practice Address - Phone:598-795-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6577103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGE W50526Medicare ID - Type UnspecifiedMEDICARE B PROVIDER