Basic Information
| Provider Information | |||||||||
| NPI: | 1902410905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RESNICK | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | SIMPSON | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 289 GREAT RD STE G1 | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017204766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 289 GREAT RD STE G1 | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017204766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2020 | ||||||||
| LastUpdateDate: | 09/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.