| Advanced Neurotherapy, Pc | |
|
140 Bristol Rd Wellesley MA 02481-2730 | |
| (781) 444-9115 | |
| Not Available |
| Full Name | Advanced Neurotherapy, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 140 Bristol Rd, Wellesley, Massachusetts |
| Authorized Official Name and Position | Jolene Ross (LICENSED PSYCHOLOGIST/DIRECTOR) |
| Authorized Official Contact | 7814449115 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Neurotherapy, Pc 10436 Park Tree Pl Glen Allen VA 23060-4487 Ph: (781) 444-9115 | Advanced Neurotherapy, Pc 140 Bristol Rd Wellesley MA 02481-2730 Ph: (781) 444-9115 |
| NPI Number | 1104846476 |
|---|---|
| Provider Enumeration Date | 07/20/2006 |
| Last Update Date | 06/15/2023 |
| Certification Date | 06/15/2023 |
| Medicare PECOS PAC ID | 4385746569 |
|---|---|
| Medicare Enrollment ID | O20070219000138 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104846476 | NPI | - | NPPES |
| 722869 | Other | MA | TUFTS COMMERCIAL |
| W03950 | Other | MA | BCBS PROVIDER # |
| W03950 | Other | MA | NATIONAL HERITAGE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TB0200X | Psychologist - Cognitive & Behavioral | 3976 (Massachusetts) | Primary |
| Provider Name | Jolene Ross |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477605236 PECOS PAC ID: 3072584184 Enrollment ID: I20040803000830 |
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