Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 10978-PY-PR | MA |
NPI | 1124540190 |
---|---|
Provider Name | Adam Michael Reid |
First Address | Arlington, MA 02476-4738 |
Second Address | Arlington, MA 02476-4738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2017 |
Last Update Date | 20/04/2020 |