Basic Information
Provider Information
NPI: 1528059847
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EPSTEIN
FirstName: BENNET
MiddleName: S
NamePrefix: DR.
NameSuffix:  
Credential: PSYD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 75 WASHINGTON ST
Address2:  
City: NORWELL
State: MA
PostalCode: 020619147
CountryCode: US
TelephoneNumber: 7818785200
FaxNumber:  
Practice Location
Address1: 75 WASHINGTON ST
Address2:  
City: NORWELL
State: MA
PostalCode: 020619147
CountryCode: US
TelephoneNumber: 7818785200
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/04/2005
LastUpdateDate: 01/05/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X3660MAY Behavioral Health & Social Service ProvidersPsychologist 

ID Information
IDTypeStateIssuerDescription
04229784501MADOC FIRSTOTHER
04229784501MAGIC UNICAREOTHER
04229784501MAPRIVATE HEALTHCARE SYSTEMOTHER
270776001MAAETNAOTHER
04229784501MAGREAT WEST HEALTH CAREOTHER
70312901MATUFTSOTHER
04229784501MACIGNAOTHER
04229784501MATRICAREOTHER
04229784501MAUNITED HEALTH CAREOTHER
04229784501MAHCVMOTHER
W0372101MABCBSOTHER
100571501MANHPOTHER
204055401MACIGNAOTHER
32940101MAHVD PILGRIM HEALTH CAREOTHER


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