Provider Demographics
NPI:1568420636
Name:VAN ORMER, E. ALICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:E.
Middle Name:ALICE
Last Name:VAN ORMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SPRINGS RD
Mailing Address - Street 2:PSYCHOLOGY (116B); ENRM VAMC
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-1114
Mailing Address - Country:US
Mailing Address - Phone:781-687-3015
Mailing Address - Fax:781-697-3228
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:PSYCHOLOGY (116B); ENRM VAMC
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-3015
Practice Address - Fax:781-697-3228
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7974103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling