Provider Demographics
NPI:1194031799
Name:CENTER FOR PSYCHIATRIC MEDICINE PC
Entity Type:Organization
Organization Name:CENTER FOR PSYCHIATRIC MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER/OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-259-0865
Mailing Address - Street 1:451 ANDOVER ST STE 205
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5079
Mailing Address - Country:US
Mailing Address - Phone:781-259-0865
Mailing Address - Fax:
Practice Address - Street 1:451 ANDOVER ST STE 205
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5079
Practice Address - Country:US
Practice Address - Phone:781-259-0865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53828103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty