Provider Demographics
NPI:1447636352
Name:ANCORA PSYCHOLOGICAL, PLLC
Entity type:Organization
Organization Name:ANCORA PSYCHOLOGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:MERRILL
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:781-224-4202
Mailing Address - Street 1:591 NORTH AVE
Mailing Address - Street 2:DOOR #3, FIRST FLOOR
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1647
Mailing Address - Country:US
Mailing Address - Phone:781-224-4202
Mailing Address - Fax:781-224-4203
Practice Address - Street 1:591 NORTH AVE
Practice Address - Street 2:DOOR #3, FIRST FLOOR
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1647
Practice Address - Country:US
Practice Address - Phone:781-224-4202
Practice Address - Fax:781-224-4203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty