Provider Demographics
NPI:1740616556
Name:THINK-DIFF INSTITUTE
Entity type:Organization
Organization Name:THINK-DIFF INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PANDORA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MACLEAN-HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-726-3444
Mailing Address - Street 1:176 WATER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3144
Mailing Address - Country:US
Mailing Address - Phone:978-726-3444
Mailing Address - Fax:978-477-0312
Practice Address - Street 1:1666 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE F1
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-5317
Practice Address - Country:US
Practice Address - Phone:978-726-3444
Practice Address - Fax:978-477-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110705251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22747OtherMEDICARE NUMBER