Individual
MENATALLA ADS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1047
(617) 665-1600
Mailing address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1047
(617) 665-1000
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
11071
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/25/2015
Last updated
07/12/2019
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