Provider Demographics
NPI:1235255589
Name:HAMOLSKY, DAVID J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:HAMOLSKY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 WESTMINSTER ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4727
Mailing Address - Country:US
Mailing Address - Phone:978-345-0685
Mailing Address - Fax:978-342-8495
Practice Address - Street 1:545 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4727
Practice Address - Country:US
Practice Address - Phone:978-345-0685
Practice Address - Fax:978-342-8495
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7364103TA0400X, 103TC2200X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7364OtherLICD PSYCHOLOGIST PROVIDE
MAHA W51069Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID