Provider Demographics
NPI:1841460730
Name:UNIVERSITY OF MASSACHUSETTS
Entity type:Organization
Organization Name:UNIVERSITY OF MASSACHUSETTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:IRSFELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-856-5145
Mailing Address - Street 1:275A BELMONT STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1675
Mailing Address - Country:US
Mailing Address - Phone:508-856-5145
Mailing Address - Fax:508-856-1378
Practice Address - Street 1:275A BELMONT STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1675
Practice Address - Country:US
Practice Address - Phone:508-856-5145
Practice Address - Fax:508-856-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty