Provider Demographics
NPI:1629291901
Name:CENTER FOR NEUROINTEGRATIVE SEVICES INC
Entity Type:Organization
Organization Name:CENTER FOR NEUROINTEGRATIVE SEVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:978-256-3093
Mailing Address - Street 1:29 REGINA DR
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4540
Mailing Address - Country:US
Mailing Address - Phone:978-256-3093
Mailing Address - Fax:
Practice Address - Street 1:42 WASHINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1803
Practice Address - Country:US
Practice Address - Phone:781-416-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6903103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6903OtherSTATE LIC