Provider Demographics
NPI:1376380006
Name:RESTORE PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:RESTORE PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:413-245-1487
Mailing Address - Street 1:12 ST CLAIR RD
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01010-2120
Mailing Address - Country:US
Mailing Address - Phone:413-245-1487
Mailing Address - Fax:413-895-6589
Practice Address - Street 1:12 ST CLAIR RD
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-2120
Practice Address - Country:US
Practice Address - Phone:413-245-1487
Practice Address - Fax:413-895-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty