Provider Demographics
NPI:1598770984
Name:PSYCH CARE ASSOC PC
Entity Type:Organization
Organization Name:PSYCH CARE ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:QAYYUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-583-6750
Mailing Address - Street 1:77 WINSOR ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-3469
Mailing Address - Country:US
Mailing Address - Phone:413-583-6750
Mailing Address - Fax:413-589-7001
Practice Address - Street 1:77 WINSOR ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-3469
Practice Address - Country:US
Practice Address - Phone:413-583-6750
Practice Address - Fax:413-589-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABCBS OF MAOtherM19012