Provider Demographics
NPI:1710056486
Name:M. GORMAN PSYCHOLOGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:M. GORMAN PSYCHOLOGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, BRENNER ASSESSM
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-327-6777
Mailing Address - Street 1:ONE WELLS AVE
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:617-327-6777
Mailing Address - Fax:617-323-6969
Practice Address - Street 1:ONE WELLS AVE
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-327-6777
Practice Address - Fax:617-323-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9762761Medicaid
MA9762761Medicaid