Provider Demographics
NPI:1588798524
Name:PACKARD, WILLIAMJ BRUCE (PHD, PSYA, LMHC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAMJ
Middle Name:BRUCE
Last Name:PACKARD
Suffix:
Gender:M
Credentials:PHD, PSYA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 THATCHER RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-3214
Mailing Address - Country:US
Mailing Address - Phone:508-254-4918
Mailing Address - Fax:508-824-9451
Practice Address - Street 1:12 THATCHER RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-3214
Practice Address - Country:US
Practice Address - Phone:508-254-4918
Practice Address - Fax:508-824-9451
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health