Individual
PAULINA FUENTES MOAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-8200
Mailing address
92 LACONIA ST, LEXINGTON, MA 02420-2230
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
11187
MA
Other
Enumeration date
07/01/2011
Last updated
08/22/2022
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