Provider Demographics
NPI:1700106440
Name:GREYWOLF PSYCHIATRY SERVICES PLLC
Entity Type:Organization
Organization Name:GREYWOLF PSYCHIATRY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREYWOLF
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:508-898-8650
Mailing Address - Street 1:1 NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2406
Mailing Address - Country:US
Mailing Address - Phone:508-898-8650
Mailing Address - Fax:
Practice Address - Street 1:21 LONGMEADOW RD
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2419
Practice Address - Country:US
Practice Address - Phone:508-898-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty