Provider Demographics
NPI:1225223753
Name:PSYCHOLOGICAL &COUNSELING SERVICE ASSOCIATES
Entity Type:Organization
Organization Name:PSYCHOLOGICAL &COUNSELING SERVICE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRUNILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:413-736-0395
Mailing Address - Street 1:80 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3427
Mailing Address - Country:US
Mailing Address - Phone:413-732-1220
Mailing Address - Fax:413-732-1228
Practice Address - Street 1:80 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3427
Practice Address - Country:US
Practice Address - Phone:413-732-1220
Practice Address - Fax:413-732-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6342103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW50741Medicaid
MAW50741Medicare PIN
MAW50741Medicare UPIN