Provider Demographics
NPI:1750438248
Name:SASSEN, GEORGIA (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:
Last Name:SASSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOLTON RD BOX 35
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-0035
Mailing Address - Country:US
Mailing Address - Phone:978-456-7366
Mailing Address - Fax:
Practice Address - Street 1:BOLTON RD BOX 35
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-0035
Practice Address - Country:US
Practice Address - Phone:978-456-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4015 PY103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical