Provider Demographics
NPI:1225110281
Name:ABDELL, ROGER F (EDD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:F
Last Name:ABDELL
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 UNION STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2241
Mailing Address - Country:US
Mailing Address - Phone:617-964-1042
Mailing Address - Fax:
Practice Address - Street 1:93 UNION ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2244
Practice Address - Country:US
Practice Address - Phone:617-964-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1094103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01003OtherBLUE CROSS / BLUE SHEILD
MAAB-W01003Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER