Basic Information
| Provider Information | |||||||||
| NPI: | 1962990952 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCEAN GEM PSYCHOLOGICAL CARE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 HIGHLAND AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019702141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174313990 | ||||||||
| FaxNumber: | 9787404902 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 HIGHLAND AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019702141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174313990 | ||||||||
| FaxNumber: | 9787404902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2018 | ||||||||
| LastUpdateDate: | 04/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | DIGIAMMARINO | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6174313990 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0850X | 10665 | MA | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | 261QM0855X | 10665 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
No ID Information.