Provider Demographics
NPI:1184818924
Name:HOPE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:HOPE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:SLAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-402-2442
Mailing Address - Street 1:16 CLARKE ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4988
Mailing Address - Country:US
Mailing Address - Phone:781-402-2442
Mailing Address - Fax:781-402-1744
Practice Address - Street 1:16 CLARKE ST
Practice Address - Street 2:SUITE 21
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4988
Practice Address - Country:US
Practice Address - Phone:781-402-2442
Practice Address - Fax:781-402-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0005220OtherMEDICARE (PTAN) ACTIVEPROVIDER TRANSACTION ACCESS NUMBER