Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 6720 | MA |
N | 103T00000X | Psychologist | 6720 | MA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 6720 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 6720 | MA |
Y | 103G00000X | Clinical Psychologist | 6720 | MA |
Y | 103TC0700X | Clinical Psychologist | 6720 | MA |
N | 103TH0100X | Health Service | 6720 | MA |
NPI | 1023028123 |
---|---|
Provider Name | Barbara L Niles |
First Address | Boston, MA 02130-4817 |
Second Address | Boston, MA 02130-4817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 21/05/2015 |