Provider Demographics
NPI:1053716829
Name:WOBURN PEDIATRIC PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:WOBURN PEDIATRIC PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRARCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-638-1020
Mailing Address - Street 1:7 ALFRED ST
Mailing Address - Street 2:BALDWIN PARK II
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1976
Mailing Address - Country:US
Mailing Address - Phone:781-933-6236
Mailing Address - Fax:
Practice Address - Street 1:7 ALFRED ST
Practice Address - Street 2:BALDWIN PARK II
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1976
Practice Address - Country:US
Practice Address - Phone:781-933-6236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOBURN PEDIATRIC ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty