Provider Demographics
NPI:1215295597
Name:ABELARD PSYCHOTHERAPY INC.
Entity type:Organization
Organization Name:ABELARD PSYCHOTHERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ABELARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-721-1153
Mailing Address - Street 1:450 PEARL ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:450 PEARL ST
Practice Address - Street 2:SUITE 3
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1610
Practice Address - Country:US
Practice Address - Phone:781-344-0057
Practice Address - Fax:781-344-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231520163WP0809X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1215295597Medicaid