Provider Demographics
NPI:1518184183
Name:YOUD, PAUL F
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:YOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HARDWICK RD
Mailing Address - Street 2:P.O. BOX 406
Mailing Address - City:PETERSHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01366-9701
Mailing Address - Country:US
Mailing Address - Phone:978-724-0215
Mailing Address - Fax:
Practice Address - Street 1:16 HARDWICK RD
Practice Address - Street 2:
Practice Address - City:PETERSHAM
Practice Address - State:MA
Practice Address - Zip Code:01366-9701
Practice Address - Country:US
Practice Address - Phone:978-724-0215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1036103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WO4372Medicare ID - Type Unspecified