Provider Demographics
NPI:1689749756
Name:CHICK, DAVID A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:CHICK
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 1:3 GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1548
Mailing Address - Country:US
Mailing Address - Phone:978-692-8334
Mailing Address - Fax:
Practice Address - Street 1:16 CLARKE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4988
Practice Address - Country:US
Practice Address - Phone:781-402-2442
Practice Address - Fax:781-402-1744
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7975103TC0700X
FL4773103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACH W51235Medicare ID - Type UnspecifiedPSYCHOLOGIST