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Individual

DR. ALBERT WALLACE DECKEL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
382 W MAIN ST, SUITE 202, NORTHBOROUGH, MA 01532-2157
(508) 393-3820
(505) 393-3814
Mailing address
PO BOX 605, NORTH GRAFTON, MA 01536-0605
(508) 393-3820
(508) 393-3814

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
8183
MA
103T00000X
Psychologist
8183
MA
103TC0700X
Clinical Psychologist
8183
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0522791
MA
Enumeration date
07/13/2005
Last updated
08/15/2014
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