Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 4892 | MA |
NPI | 1003351388 |
---|---|
Provider Name | Dr. John Charles Pakstis |
First Address | Andover, MA 01810-2953 |
Second Address | Andover, MA 01810-3751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2016 |
Last Update Date | 22/12/2016 |