Provider Demographics
NPI:1326103201
Name:ABBOTT, GEORGE EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CENTER ST
Mailing Address - Street 2:SUITE 327
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3031
Mailing Address - Country:US
Mailing Address - Phone:413-534-1888
Mailing Address - Fax:413-538-5192
Practice Address - Street 1:16 CENTER ST
Practice Address - Street 2:SUITE 327
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3031
Practice Address - Country:US
Practice Address - Phone:413-534-1888
Practice Address - Fax:413-538-5192
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4476103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4476OtherSTATE PSYCHOLOGIST LICENS
AB W50550Medicare ID - Type Unspecified