Individual
DR. MELISSA SUZANNEMARIA WATTENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
251 CAUSEWAY ST, VA BOSTON HEALTHCARE SYSTEM OUTPATIENT CLINIC, BOSTON, MA 02114-2148
(617) 248-1089
(617) 248-1287
Mailing address
251 CAUSEWAY ST, VA BOSTON HEALTHCARE SYSTEM OUTPATIENT CLINIC, BOSTON, MA 02114-2148
(617) 248-1089
(617) 248-1287
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6346
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006346
TUFTS PROVIDER NUMBER
MA
05
—
1892894
—
MA
01
—
6346
MA LICENSE #
MA
01
—
W05873
BCBS PROVIDER #
MA
Enumeration date
10/09/2006
Last updated
07/09/2007
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