Provider Demographics
NPI:1225558885
Name:PSYCHOLOGICAL SERVICES OF ANDOVER, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICES OF ANDOVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NUNING
Authorized Official - Middle Name:T
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:978-222-9901
Mailing Address - Street 1:18 RAILROAD STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-222-9901
Mailing Address - Fax:
Practice Address - Street 1:18 RAILROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3570
Practice Address - Country:US
Practice Address - Phone:978-222-9901
Practice Address - Fax:978-824-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9290103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty