Provider Demographics
NPI:1588866412
Name:COGNITIVE & BEHAVIOR THERAPIES OF NEWBURYPORT, P.C.
Entity type:Organization
Organization Name:COGNITIVE & BEHAVIOR THERAPIES OF NEWBURYPORT, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LONGPRE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:978-462-8160
Mailing Address - Street 1:150 MERRIMAC ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2357
Mailing Address - Country:US
Mailing Address - Phone:978-462-8160
Mailing Address - Fax:978-358-0037
Practice Address - Street 1:150 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2357
Practice Address - Country:US
Practice Address - Phone:978-462-8160
Practice Address - Fax:978-358-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW10501OtherBLUE CROSS BLUE SHIELD
MAW40036Medicare ID - Type Unspecified