Provider Demographics
NPI:1265922371
Name:CRONIN-GOLOMB, ALICE (PHD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:CRONIN-GOLOMB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1145
Mailing Address - Country:US
Mailing Address - Phone:781-944-0222
Mailing Address - Fax:
Practice Address - Street 1:669 PEARL ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-1145
Practice Address - Country:US
Practice Address - Phone:781-944-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6016-PY-PY103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist