Individual
DR. SHARON J WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1101 BEACON ST, 8 EAST, BROOKLINE, MA 02446-5587
(617) 731-9199
Mailing address
1101 BEACON ST, 8 EAST, BROOKLINE, MA 02446-5587
(617) 731-9199
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7490
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W05817
BLUE CROSS BLUE SHIELD
MA
Enumeration date
01/04/2007
Last updated
07/08/2007
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