Provider Demographics
NPI:1891169454
Name:FAMILY WORKS PSYCHOLOGICAL AND ASSESSMENT SERVICES
Entity Type:Organization
Organization Name:FAMILY WORKS PSYCHOLOGICAL AND ASSESSMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:WAHBA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:508-791-1454
Mailing Address - Street 1:354 W BOYLSTON ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2373
Mailing Address - Country:US
Mailing Address - Phone:508-791-1454
Mailing Address - Fax:508-791-3318
Practice Address - Street 1:354 W BOYLSTON ST
Practice Address - Street 2:SUITE 224
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2373
Practice Address - Country:US
Practice Address - Phone:508-791-1454
Practice Address - Fax:508-791-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW51408Medicare UPIN