Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 9989 | MA |
Y | 103TC0700X | Clinical Psychologist | 9989 | MA |
NPI | 1003149972 |
---|---|
Provider Name | Corey Baechel |
First Address | Needham, MA 02494-2726 |
Second Address | Burlington, MA 01803-3803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2009 |
Last Update Date | 18/11/2014 |