Provider Demographics
NPI:1497993190
Name:ACTON COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:ACTON COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:FERRELL
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:978-263-4381
Mailing Address - Street 1:110 HAVERHILL RD STE 218
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2149
Mailing Address - Country:US
Mailing Address - Phone:978-263-4381
Mailing Address - Fax:646-219-7109
Practice Address - Street 1:110 HAVERHILL RD STE 218
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2149
Practice Address - Country:US
Practice Address - Phone:978-263-4381
Practice Address - Fax:646-219-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10161Medicare UPIN