NPI 1104846476 · live from the CMS NPI Registry
Advanced Neurotherapy, PC
Psychologist, Cognitive & Behavioral in Wellesley, MA. National Provider Identifier 1104846476, active.
NPI record
| NPI | 1104846476 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Psychologist, Cognitive & Behavioral 103TB0200X |
| Practice location | 140 Bristol Rd, Wellesley, MA 02481 |
| Practice phone | 781-444-9115 |
| Mailing address | 10436 Park Tree Pl, Glen Allen, VA 23060 |
| Enumerated | July 20, 2006 |
| Last updated | June 15, 2023 |
| Authorized official | Jolene Ross, Licensed Psychologist/Director |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychologist, Cognitive & Behavioral primary | 103TB0200X | 3976 (MA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.