Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 11376 | MA |
N | 103T00000X | Psychologist | 11376 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103TH0100X | Health Service | 11376 | MA |
NPI | 1053925883 |
---|---|
Provider Name | Cyrielle Andrew |
First Address | Norwood, MA 02062-5233 |
Second Address | Boston, MA 02114-2696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2020 |
Last Update Date | 29/12/2021 |