Provider Demographics
NPI:1306036348
Name:NORTH SHORE PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:NORTH SHORE PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:978-468-7671
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-2567
Mailing Address - Country:US
Mailing Address - Phone:978-468-7671
Mailing Address - Fax:978-468-9720
Practice Address - Street 1:135 MAIN ST
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984-1543
Practice Address - Country:US
Practice Address - Phone:978-468-7671
Practice Address - Fax:978-468-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4602103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO4426OtherBC/BS
MAWO4426OtherBC/BS