Provider Demographics
NPI:1578670881
Name:BALDPATE PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:BALDPATE PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HATHAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-352-2131
Mailing Address - Street 1:83 BALDPATE RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833
Mailing Address - Country:US
Mailing Address - Phone:978-352-2131
Mailing Address - Fax:
Practice Address - Street 1:83 BALDPATE RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833
Practice Address - Country:US
Practice Address - Phone:978-352-2131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABAM12617OtherBLUE CROSS
104892OtherMAGELLAN
MA1899473Medicaid
MAM12617Medicare ID - Type Unspecified