Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 229863 | MA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 239893 | MA |
NPI | 1043365927 |
---|---|
Provider Name | Amy Pearsall |
First Address | Brookline, MA 02446-2917 |
Second Address | Brookline, MA 02446-2917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 30/01/2020 |