Provider Demographics
NPI:1578547485
Name:VICKERS, MICHAEL I (PHD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:I
Last Name:VICKERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SPEEN ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-1898
Mailing Address - Country:US
Mailing Address - Phone:508-877-3660
Mailing Address - Fax:508-872-6330
Practice Address - Street 1:40 SPEEN ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-1898
Practice Address - Country:US
Practice Address - Phone:508-877-3660
Practice Address - Fax:508-872-6330
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1477103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist