Provider Demographics
NPI:1942401427
Name:BEDFORD PSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:BEDFORD PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-275-7555
Mailing Address - Street 1:110 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2729
Mailing Address - Country:US
Mailing Address - Phone:781-275-7555
Mailing Address - Fax:781-275-7555
Practice Address - Street 1:110 GREAT RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-2729
Practice Address - Country:US
Practice Address - Phone:781-275-7555
Practice Address - Fax:781-275-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2402103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty