Provider Demographics
NPI:1770537284
Name:CARGILL, BYRON (PHD)
Entity type:Individual
Prefix:DR
First Name:BYRON
Middle Name:
Last Name:CARGILL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3778
Mailing Address - Country:US
Mailing Address - Phone:508-778-9190
Mailing Address - Fax:815-642-4596
Practice Address - Street 1:218 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3778
Practice Address - Country:US
Practice Address - Phone:508-778-9190
Practice Address - Fax:815-642-4596
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6953103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0500674Medicaid
MAW50089Medicare ID - Type UnspecifiedPROVIDER ID