Provider Demographics
NPI:1659506228
Name:CRANBERRY COUNSELING PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CRANBERRY COUNSELING PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:781-837-5344
Mailing Address - Street 1:210 WINTER ST STE 303
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-3336
Mailing Address - Country:US
Mailing Address - Phone:781-837-5344
Mailing Address - Fax:781-803-2728
Practice Address - Street 1:210 WINTER ST STE 303
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-3336
Practice Address - Country:US
Practice Address - Phone:781-837-5344
Practice Address - Fax:781-803-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TC0700X
MA3821103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty