Organization
HEIDI LACK, PHD, ATR-BC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HEIDI LACK PHD, ATR-BC (DIRECTOR, PSYCHOLOGISTART THERAPIST)
(781) 863-8696
Entity
Organization
Contact information
Practice address
16 CLARKE ST STE 23, LEXINGTON, MA 02421-4938
(781) 863-8696
Mailing address
16 CLARKE ST STE 23, LEXINGTON, MA 02421-4938
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
7518
MA
261QM0850X
Adult Mental Health Clinic/Center
7518
MA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
7518
MA
Other
Enumeration date
07/14/2014
Last updated
07/14/2014
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