Provider Demographics
NPI:1508106238
Name:PEIFER PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:PEIFER PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:PEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-213-0747
Mailing Address - Street 1:105 GREENLODGE ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-6220
Mailing Address - Country:US
Mailing Address - Phone:617-213-0747
Mailing Address - Fax:
Practice Address - Street 1:105 GREENLODGE ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6220
Practice Address - Country:US
Practice Address - Phone:617-213-0747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-16
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9248103TC0700X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9248OtherPSYCHOLOGY LICENSE NUMBER