Provider Demographics
NPI:1477628774
Name:EPHRAIM, NORMAN A (EDD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:A
Last Name:EPHRAIM
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:NORM
Other - Middle Name:
Other - Last Name:EPHRAIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3 OAKDALE LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-1710
Mailing Address - Country:US
Mailing Address - Phone:781-259-9911
Mailing Address - Fax:
Practice Address - Street 1:3 OAKDALE LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-1710
Practice Address - Country:US
Practice Address - Phone:781-259-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3961103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling