Provider Demographics
NPI:1841375995
Name:COMMONWEALTH FAMILY PSYCHOLOGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:COMMONWEALTH FAMILY PSYCHOLOGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LONGIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:978-744-5006
Mailing Address - Street 1:204 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4721
Mailing Address - Country:US
Mailing Address - Phone:978-744-5006
Mailing Address - Fax:978-744-9799
Practice Address - Street 1:204 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4721
Practice Address - Country:US
Practice Address - Phone:978-744-5006
Practice Address - Fax:978-744-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA702714OtherTUFTS HEALTH PLAN
MAW10108OtherBCBS OF MA
MAW10108OtherBCBS OF MA