Individual
THERESA WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1775 MASSACHUSETTS AVE STE 3, LEXINGTON, MA 02420-5322
(315) 404-9554
Mailing address
1775 MASSACHUSETTS AVE STE 3, LEXINGTON, MA 02420-5322
(315) 404-9554
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
11603
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000000
N/A
—
Enumeration date
12/10/2020
Last updated
08/15/2025
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