Provider Demographics
NPI:1265444889
Name:SVAJIAN, GEORGE (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:SVAJIAN
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 1:1244 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1973
Mailing Address - Country:US
Mailing Address - Phone:508-824-1780
Mailing Address - Fax:508-824-5572
Practice Address - Street 1:1244 BROADWAY
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1973
Practice Address - Country:US
Practice Address - Phone:508-824-1780
Practice Address - Fax:508-824-5572
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1023103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO1337Medicare ID - Type Unspecified