Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 11172 | MA |
Y | 103TC0700X | Clinical Psychologist | 11172 | MA |
NPI | 1003348087 |
---|---|
Provider Name | Annemarie Baldauf |
First Address | Cambridge, MA 02139-1047 |
Second Address | Cambridge, MA 02139-1047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 10/12/2019 |