Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 3071-PY-PR | MA |
NPI | 1073002648 |
---|---|
Provider Name | Duane Cromwell |
First Address | Groton, MA 01450-1358 |
Second Address | Groton, MA 01450-1358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2018 |
Last Update Date | 09/05/2018 |