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Provider Information for 1962502260

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: 1962502260

Calendar   Last Updated:  2015-08-26
  Certification Date: 


Name Value
NPI 1962502260
Enumeration Date 2006-09-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 65 CORNWALL ST UNIT 111
JAMAICA PLAIN, MA 02130-2695
United States

Phone: 617-524-0576 | Fax:
View Map External Link
Primary Practice Address 300 LONGWOOD AVE
BOSTON, MA 02115-5724
United States

Phone: 617-355-2137 | Fax: 617-739-0049
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
Yes 2080P0006X - Pediatrics Developmental - Behavioral Pediatrics MI 153860
No 208000000X - Pediatrics MA 153860