Provider Demographics
NPI:1720716525
Name:SOMERVILLE PSYCH CONSULTATION INC.
Entity Type:Organization
Organization Name:SOMERVILLE PSYCH CONSULTATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-202-5550
Mailing Address - Street 1:PO BOX 1196
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:626-202-5550
Mailing Address - Fax:626-270-7002
Practice Address - Street 1:201 W 4TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:626-202-5550
Practice Address - Fax:626-270-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty