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Provider Information for 1053427146

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1053427146

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1053427146
Enumeration Date 2006-08-22
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 151 DAVIS AVE
BROOKLINE, MA 02445-6001
United States

Phone: 617-566-2175 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE FEGAN 10
BOSTON, MA 02115-5724
United States

Phone: 617-355-8406 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other BCBS MA W0593
Primary Taxonomy Selected Taxonomy State License Number
Yes 103T00000X - Psychologist MA 6131