Provider Demographics
NPI:1750917506
Name:ENDEAVOR PSYCHOLOGY AND CONSULTING LLC
Entity type:Organization
Organization Name:ENDEAVOR PSYCHOLOGY AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-207-4124
Mailing Address - Street 1:71 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2054
Mailing Address - Country:US
Mailing Address - Phone:617-817-8513
Mailing Address - Fax:
Practice Address - Street 1:12 SPRING ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3314
Practice Address - Country:US
Practice Address - Phone:617-207-4124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty