Provider Demographics
NPI:1962990952
Name:OCEAN GEM PSYCHOLOGICAL CARE, PLLC
Entity type:Organization
Organization Name:OCEAN GEM PSYCHOLOGICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DIGIAMMARINO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-431-3990
Mailing Address - Street 1:57 HIGHLAND AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2141
Mailing Address - Country:US
Mailing Address - Phone:617-431-3990
Mailing Address - Fax:978-740-4902
Practice Address - Street 1:57 HIGHLAND AVE FL 4
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2141
Practice Address - Country:US
Practice Address - Phone:617-431-3990
Practice Address - Fax:978-740-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10665261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health