Fresh Start Psychological Services LLC

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

License

7734 Issued in MA

Legal business name

FRESH START PSYCHOLOGICAL SERVICES LLC

Practice address

18 Railroad St Ste 1
Andover, MA 01810-3570

Phone

(978) 222-9818

Fax

(978) 824-9475

NPI assigned

Jun 18, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Diane Green Reilly, PHD

Title

Manager

Phone

(978) 222-9818

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1629508171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 RAILROAD ST STE 1",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103570",
            "telephone_number": "978-222-9818",
            "fax_number": "978-824-9475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 RAILROAD ST STE 1",
            "city": "ANDOVER",
            "state": "MA",
            "postal_code": "018103570",
            "telephone_number": "978-222-9818",
            "fax_number": "978-824-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH START PSYCHOLOGICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "REILLY",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "GREEN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "978-222-9818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Counseling",
            "state": "MA",
            "license": "7734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1821363615",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jo-Ann Marie Fortier, MSN
• Susan J. Foster
• Franklin Dorian Segall, M.D.
• Lisa Rebecca Freedman, MS ED, BCBA
• Mark A Freeman
• Bahaar Frost, MS, RD, LDN
• Erin Gabriel, LCSW
• Diane Marie Gallant
• Leslie Ganley, LICSW
• Christine Garcia, LMHC

• Counseling Psychologist in Andover, MA
• Providers in Andover, MA by specialty
• Counseling Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.