Provider Demographics
NPI:1811169238
Name:BILLERICA COUNSELING CENTER
Entity type:Organization
Organization Name:BILLERICA COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGUAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-572-4550
Mailing Address - Street 1:572 BOSTON RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3776
Mailing Address - Country:US
Mailing Address - Phone:781-572-4550
Mailing Address - Fax:
Practice Address - Street 1:572 BOSTON RD
Practice Address - Street 2:SUITE 14
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3776
Practice Address - Country:US
Practice Address - Phone:781-572-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2402103TC2200X
MA8678103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty