Provider Demographics
NPI:1548347610
Name:UNITED CHURCH OF CHRIST
Entity type:Organization
Organization Name:UNITED CHURCH OF CHRIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:DELAPLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-871-2051
Mailing Address - Street 1:PO BOX 2025
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351
Mailing Address - Country:US
Mailing Address - Phone:781-871-2051
Mailing Address - Fax:781-871-5558
Practice Address - Street 1:10 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351
Practice Address - Country:US
Practice Address - Phone:781-871-2051
Practice Address - Fax:781-871-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6086103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04897Medicare ID - Type Unspecified
=========0001Medicare UPIN