Provider Demographics
NPI:1881998276
Name:PARKER, IDA K (IDA PARKER)
Entity type:Individual
Prefix:MS
First Name:IDA
Middle Name:K
Last Name:PARKER
Suffix:
Gender:F
Credentials:IDA PARKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 935
Mailing Address - Street 2:
Mailing Address - City:MANOMET
Mailing Address - State:MA
Mailing Address - Zip Code:02345-0935
Mailing Address - Country:US
Mailing Address - Phone:508-789-6570
Mailing Address - Fax:
Practice Address - Street 1:545 BOYLSTON ST
Practice Address - Street 2:SUITE 700
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3606
Practice Address - Country:US
Practice Address - Phone:508-771-2402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst