Individual
HEATHER WONG BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1 MIFFLIN PL, SUITE 260, CAMBRIDGE, MA 02138-4907
(617) 513-1004
Mailing address
632 MASSACHUSETTS AVE, APARTMENT 316, CAMBRIDGE, MA 02139-3327
(617) 513-1004
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
8260
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110076761
—
MA
01
—
9967078
AETNA
—
01
—
W 06347
BLUE CROSS BLUE SHIELD MA
MA
Enumeration date
01/29/2007
Last updated
01/18/2013
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