Provider Demographics
NPI:1053983940
Name:ATKINSON, MARK T (MED, CAGS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:MED, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DARBY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-2175
Mailing Address - Country:US
Mailing Address - Phone:408-887-7400
Mailing Address - Fax:
Practice Address - Street 1:6 DARBY LN
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:MA
Practice Address - Zip Code:01966-2175
Practice Address - Country:US
Practice Address - Phone:408-887-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190205221103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool