Provider Demographics
NPI:1326114711
Name:THE PROFESSIONAL CENTER FOR CHILD DEVELOPMENT
Entity Type:Organization
Organization Name:THE PROFESSIONAL CENTER FOR CHILD DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-475-3806
Mailing Address - Street 1:32 OSGOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-5411
Mailing Address - Country:US
Mailing Address - Phone:978-475-3806
Mailing Address - Fax:978-475-6288
Practice Address - Street 1:32 OSGOOD ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-5411
Practice Address - Country:US
Practice Address - Phone:978-475-3806
Practice Address - Fax:978-475-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA017069251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1800507Medicaid
MA0008468OtherNEIGHBORHOOD HEALTH PLAN
MA716774OtherTUFTS HEALTH PLAN
MAEI0003OtherBLUECROSS OF MA
MA0071875OtherAETNA
MA987925OtherNETWORK HEALTH
MA607902OtherHARVARD HEALTH PLAN