Individual
DR. SUCHETA THEKKEDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
85 E NEWTON ST, 912, BOSTON, MA 02118-2340
(617) 414-4646
Mailing address
780 AMERICAN LEGION HWY, BOSTON, MA 02131-3908
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
10481
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/14/2012
Last updated
05/16/2017
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