Individual
MR. SAMUEL MARK MIGDOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D
Contact information
Practice address
23 BROADWAY, BEVERLY, MA 01915-4417
(978) 922-2280
(978) 927-1758
Mailing address
23 BROADWAY, BEVERLY, MA 01915-4417
(978) 922-2280
(978) 927-1758
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
76
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096083
MHN
MA
01
—
1010630
BEACON
MA
05
—
1302892
—
MA
01
—
901877
TUFTS
MA
01
—
97964101
NETWORK HEALTH
MA
01
—
WO1232
BLUE CROSS
MA
Enumeration date
10/31/2006
Last updated
07/08/2007
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