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Provider Information for 1356419162

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: MALE

Individual NPI: 1356419162

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


Name Value
NPI 1356419162
Enumeration Date 2006-12-01
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 95 S MAIN ST
COHASSET, MA 02025-2005
United States

Phone: 781-383-1224 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-7166 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
No 2084P0800X - Psychiatry & Neurology Psychiatry MA 49410
No 2084P0804X - Psychiatry & Neurology Child & Adolescent Psychiatry MA 49410