Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 7364 | MA |
N | 103TC1900X | Counseling Psychologist | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 7364 | MA |
NPI | 1235255589 |
---|---|
Provider Name | Dr. David J. Hamolsky |
First Address | Fitchburg, MA 01420-4727 |
Second Address | Fitchburg, MA 01420-4727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7364 | LICD PSYCHOLOGIST PROVIDE (01) | MA |