Individual
BETH ANN LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
11765
MA
103TC2200X
Clinical Child & Adolescent Psychologist
PS017869
PA
103TC2200X
Clinical Child & Adolescent Psychologist
PS01916
RI
103TC2200X
Clinical Child & Adolescent Psychologist
—
DE
Other
Enumeration date
08/08/2014
Last updated
04/14/2022
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