Provider Demographics
NPI:1740807528
Name:CENTI PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:CENTI PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CENTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-863-0090
Mailing Address - Street 1:35 RENWICK RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1218
Mailing Address - Country:US
Mailing Address - Phone:617-863-0090
Mailing Address - Fax:781-876-0002
Practice Address - Street 1:35 RENWICK RD
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-1218
Practice Address - Country:US
Practice Address - Phone:617-863-0090
Practice Address - Fax:781-876-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty