| Organization Name: | PCA IN PEDIATRIC PRIMARY CARE LLC |
| NPI Number: | 1013347103 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL F JACQUES (OWNER) |
| Mailing Address: | 12 Alfred St Suite 200 Woburn |
| State: | MA US |
| Postal Code: | 018011972 |
| Phone Number: | 7816460500 |
| Fax Number: | 7816467130 |
| NPI Enumeration Date: | 11/26/2013 |
| NPI Last Update Date: | 11/26/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |