Provider Demographics
NPI:1235933656
Name:ELIOT FEAREY, PHD PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:ELIOT FEAREY, PHD PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:
Authorized Official - Last Name:FEAREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-219-5544
Mailing Address - Street 1:160 ALEWIFE BROOK PKWY # 1206
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:160 ALEWIFE BROOK PKWY # 1206
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1102
Practice Address - Country:US
Practice Address - Phone:203-219-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty